NHS AYRSHIRE AND ARRAN
MUSCULOSKELETAL HIP PAIN PATHWAY
For further information please contact:
Judith Reid, Consultant Physiotherapist in MSK,
Crosshouse Hospital.
Email; judith.reid.aapct.scot.nhs.uk

STAGE ONE
Patient presents with Hip disorder
STAGE TWO
GP management
Self management,
Red Flags,
Known/
Suspected fracture, AVN
STAGE THREE
Referral process
Orthopaedics
STAGE FOUR
MSK TRIAGE
AND
TREATMENT
DISCHARGED
IMMEDIATE OR
URGENT
ORTHOPAEDIC
REFERRAL/ A & E
Working Health
Service/ Local
Gym
Programmes
Rheumatology
Other Acute
Services
Pain Services

Initial presentation of hip pain disorder:
RED FLAGS for possible serious Hip pathology:
Suspected/ Known Hip Fracture
Violent Trauma eg RTA/ Fall from height
Avascular Necrosis
Constant, Progressive, Non Mechanical Pain
Severe unremitting night pain
PMH Carcinoma
Systemically unwell
Structural deformity
Gross loss of movement/ mobility with severe pain
Widespread neurological signs and symptoms

In absence of need for immediate referral

Explain and reassure

Advise to stay active and working

Control symptoms

Enable self-help / management

Consider Pelvic X-ray for Osteo-Arthritis

Weight Management

Provision of walking aids

Steroid injection for Trochanteric Bursitis

Consider local gym programmes
 www.arthritiscare.org.uk ( Please find OA Booklet attached)
 www.nhsinform.co.uk
Drug Therapy
Analgesics

Paracetamol

NSAIDs

Weak Opioids

RECHECK FOR RED FLAGS/
POTENTIAL FRACTURES
IMMEDIATE OR URGENT
ORTHOPAEDIC
REFERRAL/ A & E
Consider Orthopaedic referral if

Advanced OA confirmed on X-ray

Early/ moderate OA confirmed on X-ray and no change within 3 months with conservative treatment
In the Absence of Hip OA and spinal involvement consider MSK hip
Pathway
CONSIDER REFERRAL TO MSK SERVICE FOR

Anterior Groin Pain with or without anterior thigh pain o Pain on weight bearing/ walking distance reduced o Loss of movement of hip o Sleep disturbed

Lateral Thigh Pain o Pain on palpation over Greater Trochanter and resisted hip abduction

Soft Tissue Injury o Fracture excluded on plain x-ray if indicated e.g. groin strain
PROCESS FOR REFERRALS TO MSK SERVICE
Electronic referral via SCI gateway

Musculoskeletal Triage and Treatment

Hip Pathway.
Please note: Referrals directed to Orthopaedics considered to be more suitable for MSK will be redirected
C
CONSIDER WORKING HEALTH SERVICE www.healthyworkinglives.com
www.salus.co.uk
Self refer: 0800 019 2211

Re-evaluate for worrying pathology, disorder not originating from hip
Communication with
GP, referral returned or redirected appropriately
Anterior Groin pain with or without anterior thigh pain
Lateral Thigh pain Soft Tissue Injury
Routine Physiotherapy appointment (4-6 weeks)
Physiotherapy appointment
(2 weeks)
Self management/
Discharged
If failing to progress after 4 sessions - senior clinician support
Self management/
Discharged
Pain services ESP / Combined Clinic
Imaging if required
Discharged
Orthopaedics Other acute services

APPENDIX 1
Hip OA information

hip