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Rheumatology and Sport and Exercise Medicine Triage Explained

Outcome of Rheumatology/Oxsport triage. Referral letter to Rheumatology/Oxsport. Paper triage by Consultant/ Associate specialist. Accepted GP for C

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Rheumatology and Sport and Exercise Medicine Triage Explained

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    1. Rheumatology and Sport and Exercise Medicine Triage Explained! Anne Miller and Julia Newton Nuffield Orthopaedic Centre GP MSK update Jan 2011

    2. Outcome of Rheumatology/Oxsport triage

    3. What we see in oxsport Resistant tendinopathy Bone stress/stress fractures Groin pain Back pain Exercise related lower leg pain Female athlete triad Child and adolescent exercise related problems Lack of diagnosis/regional exercise associated pain problem Injuries that have not recovered as expected

    4. Oxsport Services E mail advice/follow up oxsport@noc.nhs.uk Website with patient information sheets and exercise programs www.noc.nhs.uk/oxsport Specialist paediatric and adolescent clinic Compartment pressure testing iv bisphosphonates for bone marrow oedema syndromes in athletes Interventional treatments for resistant tendinopathy Combined clinics with orthopaedics

    5. Key points for 2 common conditions

    6. Tendinopathy Degenerative Do not inject steroid Exercise programs take at least 3 months Exercise programs hurt! Interventional treatments only after failed conservative management Risk factors Relative rest Cross training

    7. Bone Stress & Stress Fracture Impact pain Often minimal findings on examination X ray is not sensitive If negative, follow up with MRI Female athlete triad Risk factors Pain free – key to management Alternate day impact/rest days

    8. Return to sport Correct the risk factors 10% rule Difference between injury healing and sport specific fitness Cross training

    9. Rheumatology Triage

    10. Outcome of Rheumatology/Oxsport triage

    11. Rheumatology Hub clinics New dedicated rheumatology hub Two per month Booked from rheumatology triage Started December Assessments & injections e.g. confirmation OA hands and OT referral e.g. flexor tendon injections

    12. Case example Female with longstanding chronic pain Copy of London expert assessment attached Did she have SLE? Minor abnormality in ANA. Triage – rejected Reassured no evidence of SLE

    13. Outcome Return email from GP within the hour Wrong answer! Support needed in telling patient she didn’t have SLE Consultation arranged

    14. Change in practice Accompany “sent back” decisions with a letter to recommend management for GP to use with patient e.g. chronic pain patient worried about SLE Managing referrals recommended by hospital clinicians which appear inappropriate e.g. neck pain, recommended for referral by neurologist

    15. A full letter supports good triage What you think the diagnosis is Clinical findings – joint swelling etc Blood test results Previous correspondence If referral sent back and letter does not address the issues then contact me

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