MSK Pathway Information

Target Patients:
A patient will be considered eligible for referral to the service if they present with a condition thought primarily to be of MSK origin, including but not limited to orthopaedics, MSK-related pain and back/spine.


The following patients are excluded from Musculoskeletal Clinical Assessment and Treatment Service (MSK CATS) (these are not applied to the outpatient physiotherapy service):
• Children (under 18 years)
• Patients who are not registered with a Derbyshire/Derby City GP Practice 
• Immediate life-threatening conditions
• Acute trauma
• Suspected 'red flag' patients (e.g. cauda-equina, systematically unwell, significant weight loss suggestive of serious issue)

Which pathway should I follow with my musculoskeletal patient?

Patients should be referred to the relevant service for their condition highlighted below:

Podiatry 

  • Toe problems
  • Foot problems
  • Heel pain
  • Persistent ankle pain
  • Arthritis of the foot or ankle
  • Achilles Tendon problems
  • Structural and biomechanical problems of the foot and lower limb 

Physiotherapy

  • Back pain including sciatica
  • Neck pain including radiculopathy into the arm
  • Shoulder pain/trauma
  • Elbow pain
  • Hand/wrist pain
  • Hip pain
  • Knee pain
  • Ankle pain/sprain
  • Muscle and tendon injuries
  • Chronic musculoskeletal pain 

Patients seen within this service can also have access to a robust escalation process to senior clinicians who can inject, refer on to secondary care and request diagnostics. 

Service provided by DCHS & CRH also includes intra-articular and peri-articular injection therapy.

MSK Triage Service

  • Patients who have completed a course of self-management plus physiotherapy, have not improved and require further management; including referral to secondary care.
  • Patients who have completed a course of self-management plus podiatry for musculoskeletal problems, have not improved and require further management; including referral to secondary care.
  • Patients who may need referral to secondary care for injections under imaging (demonstrating that the PLCV/NICE guidelines have been followed) 

Patients should not be referred to the MSK CATS if:

  • They have not tried physiotherapy and self-management (unless the situation dictates that they were not appropriate measures to undertake prior to referral)
  • They are already receiving physiotherapy services
  • They require a visit to their home
  • They present with red flags or suspected fracture