In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .
A cost consequences analysis of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care.
OBJECTIVE Local steroid injections and community-based physiotherapy have been shown to be of similar benefit for treating shoulder pain presenting to primary care . This paper presents a cost consequences analysis of a prospect i ve economic evaluation , conducted alongside a r and omized clinical trial ( RCT ) of corticosteroid injections versus physiotherapy for new episodes of unilateral shoulder pain , to determine the economic implication s of injection versus physiotherapy . METHODS A pragmatic RCT with 207 patients r and omized to either physiotherapy ( n = 103 ) or local steroid injection ( n = 104 ) was conducted . The re source inputs required were identified for each treatment arm in terms of capital , staff and consumables . These were measured for the period up to 6 months post-r and omization . Outcome measures included shoulder disability , shoulder pain , global assessment of health change and the EQ5D , all at 6 months . A sensitivity analysis was performed around the general practitioner minor surgical fee . RESULTS Analysis is presented on the 199 patients for which the general practice record review ( 101 physiotherapy , 98 injection ) was available . The total mean costs , per patient , were 71.28 pound sterling for the injection group and 114.60 pound sterling for the physiotherapy group . The difference in average total cost per patient was 43.32 pound sterling ( 95 % bootstrap confidence interval : 16.21 pound sterling , 68.03 pound sterling ) . This is a statistically significant difference in cost . Outcome was similar in both groups across all measures following intervention . Smaller mean differences in cost were observed between the treatment groups in the sensitivity analysis , but the difference remained in favour of injection over physiotherapy . CONCLUSIONS This study has shown , given similar clinical outcomes across the treatment groups , that corticosteroid injections were the cost-effective option for patients presenting with new episodes of unilateral shoulder pain in primary care
In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .