Shoulder Arthroscopy – Criteria Led Commissioning Statement

Scope

This commissioning statement refers to

  • Excision acromioclavicular joint (Shoulder Arthroscopy)

This commissioning statement does not refer to:

  • Where is not appropriate to use Manipulation under anaesthetic:
    • Frozen shoulder associated with insulin-dependent diabetes does not respond well to manipulation under anesthesia, often refreezing within 2 to 3 weeks. If there is any history of postirradiation fibrosis, then this may well lead to loss of elasticity in the brachial plexus and put the plexus in jeopardy of a traction lesion
    • The elderly, frail, and osteoporotic should not be manipulated for fear of causing a fracture of the shaft or proximal humerus

Status

Eligibility Criteria

Shoulder arthroscopy will only be funded for patients with adhesive capsulitis ('frozen shoulder') if the following treatments have all been tried and failed:

  • (a) Activity modification
  • (b) Physiotherapy and exercise programme
  • (c) Oral analgesics including NSAIDs (unless contraindicated)
  • (d) Intra-articular steroid injections
  • (e) Manipulation under anaesthetic

GPs should not refer unless all the above have been tried and failed, and referrals must include objective information to demonstrate this.

Lifestyle Factors - Best Practice

Obesity

  • Patients with a BMI >30 should be encouraged by their Clinician to lose weight prior to surgery and signposted to appropriate support to address lifestyle factors that would improve their fitness for surgery and recovery afterwards.
  • There is a clinical balance between risk of surgical complications with obesity and the risk to delaying any surgery.
  • See Weight Management Care Pathways

Smoking

  • In line with 'Healthy Lives, Healthy People; a tobacco control plan for England', local authorities and health professionals are committed to encourage more smokers to quit.
  • Smoking remains the leading cause of preventable morbidity and premature death in England.
  • There is sufficient evidence to suggest that people who smoke have a considerably increased risk of intra- and post-operative complications such as chest infections, lung disorders, wound complications and impaired healing.
  • See Smoking Cessation Care Pathways
Please Note: The life style factors above are not a restriction to the commissioning statements unless otherwise stated

Assurance & Governance

  • This policy was developed on: 05.2017
  • This policy was approved by: Clinical Strategy Group (NK) and Clinical Cabinet (WK)
  • Date approved: 05.2017
  • Publication Date: 05.2017
  • Review Date: 04.2018
  • Ref No: PA7 - 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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