Ten Tips

Ten tips for MSK management and referrals

  1. Use standing (weight bearing) xrays as initial investigation for knee pain in patients over 60.
  2. MRI is rarely needed to plan treatment for knee pain in patients over 60, and should not routinely be ordered until osteoarthritis is ruled out by xray.  View the statement of position on arthroscopy of the knee joint for additional information.
  3. Meniscus tears in patients over 60 rarely need surgery, especially if associated with osteoarthritis. Older patients with significant mechanical symptoms such as locking or giving way without significant OA on xray may still occasionally benefit from arthroscopy.  View the statement of position on arthroscopy of the knee joint for additional information.
  4. Xray should be used for initial screening of shoulder pain in patients over 60.
  5. MRI is helpful for diagnosis and treatment planning of shoulder problems, recognizing that rotator cuff tears are common and often minimally symptomatic with advancing age.
  6. Initial treatment for chronic shoulder problems is usually conservative, with early referral for physiotherapy recommended. Physio should be initiated even if they have a documented cuff tear, or are awaiting orthopaedic consultation and possible surgery. Patients and physiotherapists should be reassured that this is entirely appropriate and safe.
  7. Patients with shoulder problems resulting from an acute injury can also benefit from physiotherapy while awaiting MRI and possible orthopaedic consultation, though earlier orthopaedic consultation is recommended.
  8. It is helpful for prioritizing shoulder consultations if the referral letter indicates if there has in fact been an acute injury, and for how long the symptoms have been present.
  9. We prefer to remove staples after knee replacement surgery ourselves at the Brandon Clinic, as some wounds take longer than two to three weeks to heal. Staples can be safely left in place for four or five weeks, and later removal is preferable to removal too early.
  10. Any significant physician concerns regarding post-operative wound infection should be directed to Dr. Klippenstein at the Brandon Clinic even with initial local management, and not delayed for a future appointment.