Introduction: Don't Blame the Scan
​In recent years, a growing number of academic papers and social media narratives have raised concerns about rising imaging rates in musculoskeletal (MSK) care. The argument is familiar: imaging doesn’t help, causes harm, and fuels overmedicalisation by assigning labels that instill fear or lead to unnecessary interventions. (1, 2) 

Adding to the argument are studies showing that “abnormal” imaging findings such as disc degeneration or rotator cuff tears, are frequently present in people without symptoms. These findings are often used to recommend avoiding imaging in symptomatic individuals and to argue that similar findings in those with pain are often incidental or irrelevant.  (3-7) Some also claim that routine imaging fails to improve outcomes like pain, function, or satisfaction.(8) Taken together, these messages have driven a narrative that imaging is overused, harmful, and clinically invalid and should therefore be broadly avoided.(4)

"Orthopaedic triage" is becoming a common term in the world of physiotherapy and musculoskeletal care. As healthcare systems evolve to meet the rising demand for elective musculoskeletal and orthopaedic services, orthopaedic triage has found itself in the spotlight.

An increasing number of physiotherapists are working in “orthopaedic triage” roles in elective (non-acute) settings in both the private and public sector. Elective services include anything that is not urgent or emergent. In New Zealand, examples of elective orthopaedic services include community-based ACC funded ICP/ECP pathways, referrals to private orthopaedic services and referrals by GPs to elective orthopaedic services in the public hospital.

​But here’s the issue – the term “orthopaedic triage” doesn’t mean the same thing to everyone. Depending on where you work or who you talk to, "orthopaedic triage" can take on different meanings, leading to confusion and inconsistent practices. A shared understanding of what “orthopaedic triage” is in the elective setting is needed to help us prepare for these roles as they emerge.

In this post, we’ll take a look at what orthopaedic triage is (and isn’t), we’ll explore definitions and why these matter, and review the purpose of triage and some of the factors that shape it. 

A few weeks ago I wrote a post about the level of clinical competency required at specialist levels of physiotherapy practice which generated a bit of interest. I mentioned that my experience of working at this level (compared with other levels of practice) is the expectation that the specialist physiotherapist will have a solution we are others have failed. Often we are ‘expected to know’. 

In the previous post I discussed some of the factors that contribute to ‘complexity’. So how do I approach and interpret my assessment and make decisions about appropriate treatment given that many people I see have already had many investigations and treatment, often from very competent professionals?

This infographic give a summary of a case I saw in 2021. This highlights the importance of red flag screening in physiotherapy. Click here for more information about red flag screening in physiotherapy.