Policy number: SRP 016
Policy name: Arthroscopy Shoulder
Status: Individual Funding Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
Mid and South Essex ICB commissions shoulder arthroscopy on a restricted basis.
Shoulder arthroscopy will only be funded for patients with adhesive capsulitis (‘frozen shoulder’) if the following treatments have all been tried and failed:
- Activity modification
- Physiotherapy and exercise programme
- Oral analgesics including NSAIDs (unless contraindicated)
- Intra-articular steroid injections
GPs should not refer unless all the above have been tried and failed, and referrals must include objective information to demonstrate this.
For the avoidance of doubt, the ICB does not commission shoulder arthroscopy
- As a diagnostic tool
OR
- For frozen shoulder or adhesive capsulitis except if the above criteria are met.
In the majority of circumstances, a clinical examination (history and physical examination) by a competent clinician will give a diagnosis and demonstrate if internal joint degeneration is present. If there is a diagnostic uncertainty despite competent examination or if there are ‘red flag’ symptoms/signs/conditions, then an MRI scan (not shoulder arthroscopy) might be indicated.
The ICB commissions shoulder arthroscopy as part of a procedural treatment i.e. as a less invasive surgical treatment which does not require prior approval. However, if used to treat adhesive capsulitis will only be funded if the above criteria are met and prior approval obtained.
Red Flag symptoms or signs including:
- Recent trauma
- Constant progressive non-mechanical pain (particularly at night)
- Previous history of cancer
- Long term steroid use
- History of drug abuse
- History of HIV
- Fever
- Being systematically unwell
- Recent unexplained weight loss
- Persistent severe restriction of joint movement
- Widespread neurological changes
- Structural deformity
- Infection, carcinoma
- Nerve root impingement
- Bony fracture
- Avascular necrosis
Providers should be aware that payment may be withheld if they cannot demonstrate that patients meet these criteria.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Find out more information on applying for funding in exceptional clinical circumstances