Introduction
tHE
pATHWAYS
The Frimley MSK Imaging pathways are designed to help local GPs identify the common spine and joint conditions seen in primary care and standardize the most appropriate methods of imaging. Variations in management, over-treatment and failure to offer evidence-based interventions leads to poorer outcomes for patient.
The pathways have been designed in conjunction with primary and secondary care. Current local practice is for any patients who are thought to require imaging to be referred to the primary care first contact MSK practitioners or secondary care directly. Any referrals for direct access imaging will require discussion with the radiology consultant who should be named on the referral. If this is agreed any primary care referral for imaging should be made via ICE. We are trying to reduce the paper requesting where possible to improve the clinical and information governance.
When imaging is indicated and agreed please refer to the individual test descriptions to include the minimum information required in the referral to enable a radiology examination to be interpreted. If there is insufficient information provided a request will be returned to the referrer.
A common theme in MSK imaging is that degenerative changes are common with increasing age and advanced imaging (US and MRI) is highly sensitive and can be associated with false positives by identifying changes which are not pathological. Increased imaging is associated with increased intervention rates and costs without long term benefits
Abnormalities found on scans in asymptomatic people
Shoulder
Age 40-70
Partial tear 32%
Bursal Thickening 78%
Overall abnormalities 95%
Hips
CAM deformity 37%
Pincer deformity 67%
Labral injury 68%
Spine
Age 20-70
Disc Bulges 87%
Knees
Age >40 yrs / < 40 yrs
OA changes 40% / 14%
Cartilage Defect 43% / 11%
Meniscal tear 19% / 4%
Foot & Ankle
Morton Neuroma 54%
ATFL pathology 37%
