Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia, physiotherapy, and joint injections; most people can be managed without an operation. Currently, there is variation in the type of joint injection: 1) CSI, thought to reduce the inflammation of the capsule reducing pain; and 2) HD, where a small volume of fluid is injected into the shoulder joint along with the steroid, aiming to stretch the capsule of the shoulder to improve pain, but also allowing greater movement. The creation of musculoskeletal hubs nationwide provides infrastructure for the early and effective management of frozen shoulder. This potentially reduces costs to individuals and the wider NHS perhaps negating the need for a secondary care referral.Aims
Methods
Pleural drains are routinely used following anterior approaches to the spine for the correction of spinal deformities, to prevent the accumulation of blood, fluids and air in the pleural cavity. Following their removal it is routine practise in our Trust to obtain chest radiographs to look out for a pneumothorax or a residual fluid collection. Our hypothesis is that unless clinically indicated the use of a CXR does not affect patient management and should not therefore be routine practice. A retrospective audit of 122 consecutive patients, who underwent surgery for the correction of spinal deformity using an anterior approach to the spine, over the course of a year, was undertaken. CXRs were performed in all patients following drain removal. We have reviewed those images and in cases were abnormalities were detected we have examined the case notes to assess the impact of those findings with regards to management.Background
Methods
