COVID-19 Adjusted Treatment Pathways
Community Physiotherapy are accepting referrals for steroid injection but only injecting those that are low risk (see exclusions below).
The service is also still accepting non-invasive referrals for musculoskeletal conditions.
Exclusions for steroid injection :
> 70 yrs old
Diabetics and patients with underlying heart and chest conditions.
Steroid injections are not currently being performed at UHCW in Musculo-Skeletal / Orthopaedics / Radiology. Please do not currently refer to UHCW for this purpose.
GP and Self-Management
Simple Elbow Pain, Tennis Elbow & Golfer’s Elbow
- Anti-inflammatory gel onto tender spot
- Advice to reduce repetitive activities
- Refer to physiotherapy early
- Inject once or twice (GP or physio)
- An x-ray may be required if there is a loss of extension or history of locking at the elbow.
- Ultrasound may be useful for looking for tendinopathy or calcific tendinopathy.
Referral to Adult Physiotherapy Service – Coventry
If advice on analgesia, relative rest and elbow support has failed, refer to the Adult Physiotherapy Service. Recent research has suggested ‘tennis’ and ‘golfers’ elbow has poorer outcomes with injections. It is imperative that Physiotherapy is considered first before trying this. If referred to physiotherapy they will be assessed and considered for the following treatments, as required:
- Specific exercises
- Elbow Clasp
- Mobilisations/ soft tissue techniques
- Steroid & local anaesthetic injection
- Dry Needling technique under guided ultrasound – Tennis & Golfers elbow only
Referral to secondary care
- Consider referral to secondary care if any of the following are present:
- Under the care of a consultant for the same condition or previous surgery for problem
- Patient is amenable to surgical intervention when all non-operative measures have been exhausted, including at least two injections, physiotherapy, splints etc.
- Known cancer or suspicion of tumour (Two Week Wait)
- Inflammatory, multi-joint or systemic presentation
- Severe restriction of flexion and extension
- Joint locking, instability
- Suspicion of fracture
- Bone disease or infection
- Rheumatological, multi-joint conditions