Your treatment can include any or all, of the following: 

• Radiotherapy.
• Endocrine medication.
• Chemotherapy.
• Surveillance mammograms. 

Please call the CNS team on 0117 414 7000 when you have completed your treatment at Bristol Haematology and Oncology Centre (BHOC). 

You will probably have the following: 

• 5-years of surveillance mammograms.
  • These are yearly appointments from the date of your surgery.
• Open access to the team.
  • If you have any worries or concerns about your breasts, you can contact the Breast Care Centre or the CNS team directly instead of your GP.
• My Medical Records (MMR).
  • Self-monitoring website, with access to your monitoring plan and results, information resources, message centre (for nonurgent queries).
• Discharge after 10 years.

Personalised care and support planning appointment:

• Within 6 months you will be offered a Holistic Needs Assessment.
• This is an appointment with one of our Cancer Support Workers to discuss moving forward.

Living Well Day (within 1 year of diagnosis):

• A day that covers multiple topics about staying well and has guest speakers.

Living Well Course:

• This is run by our psychologists and supported by the CNS and CSW team. Please ask your CNS for more details. 

Vita Health Group:

• Bristol, North Somerset and South Gloucestershire - Vita Health Group.
• You can refer yourself to talking therapies (such as counselling). 

Breast pain following treatment is very common in women of all ages. 

Three types:

• Cyclical.
• Non-cyclical.
• Referred pain. 

YouTube video explaining breast pain:

• Understanding Breast Pain

Breast pain is very common for up to 1 year post radiotherapy. If you are having trouble, we can refer you to the Late Effect Team who help with the effects of radiotherapy. 

Patients who have had a sentinel node biopsy or auxiliary node clearance, these actions may help prevent lymphoedema developing

• Massage and moisturise the area.
• Avoid breaks in the skin, use factor 50 SPF, have blood taken from and vaccines in the opposite arm from your surgery.
• Early detection helps.
• You will need an appointment with Breast Care Centre before referral to the lymphoedema team. 

Penny Brohn UK - Lymphoedema support group. 

Managing lymphoedema | Breast Cancer Now 

If you have been given post operative arm movements, keep them going. 

These can help with getting moving: 

• Energise classes – Horfield Leisure Centre and EA Stadium, Clevedon. Self-referral on Bristol City Council Website.
• NHS APP – Brisk Walking.
• Dietician – Macmillan have a self-referral form. Not specifically for weight management, but how to best 'fuel' your body.
• Fatigue – Macmillan, Bosom Buddies and Penny Brohn run courses on fatigue management.
• If you are concerned about bone density, then the site is full of useful advice: Osteoporosis: Exercise for bone health

Fatigue is more common than people think and is very different to feeling tired. 

These resources have information about fatigue and how to manage it. 

The Gloucester Team have put together 4 online videos on managing fatigue, diet, exercise and psychological wellbeing:

• How to manage fatigue

Royal College of Occupational Therapists – Managing Fatigue. Not Cancer specific:

• Lift up your everyday - managing energy | RCOT 

Breast Cancer Now – Cancer-related fatigue:

• Extreme tiredness (cancer-related fatigue) | Breast Cancer Now

If your cancer was hormone responsive, you are likely to take hormone repressive medication. 

The web sites below offer great advice: 

• Menopause Matters, menopausal symptoms, remedies, advice
• Balance - Home

Complex Menopausal Referral – can be referred by your Breast Consultant.

Touch, Look, Check

 (Even if you have had a mastectomy)

1. Check your breast once a month.
2. Stand in front of a mirror and put your arms over your head. Look for puckering,    dimples or redness to the skin.
3. Raise arm above your head and using the flat of your hand, start at the 12 o’clock position and roll to centre of breast. Complete the clock face.
4. Make sure to check your axillary tail (bit between your breast and armpit).
5. With one arm raised, check under arm and along clavicle bone. 

The CoppaFeel! website has more information and checking your breasts: How To Check Your Breasts, Pecs or Chest | CoppaFeel!

The most common recurrences (when the cancer comes back) are in the breast and most likely picked up on surveillance mammograms. 

If you have any of these for 4 weeks or more, that don’t stop at all and don’t get better with regular medication, please get in touch.

1. Persistent cough and shortness of breath.
2. Severe or on-going headaches
3. Loss of balance, weakness or numbness in limbs, altered vision
4. Pain in bones, back, hip, rib etc. that does not get better with pain relief and gets worse at night.
5. Feeling bloated or not being able to go to the toilet. Feeling full quickly or change to appetite, or unexpected weight loss.
6. Discomfort or swelling under your right rib (where your liver is). Can radiate across abdomen.
7. Feeling more tired than normal. 

Located in Pill, this is a great place with multiple treatment support programmes, or just to have a very tasty lunch!

• Regular group sessions/in person activities – Yoga, relaxation, nutrition support, QI Gong, creativity workshops, strength and stamina classes.
• Self-care resources
• Personal consultations
• Visit the grounds for a walk
• Go to the café. 

Penny Brohn UK – Cancer wellbeing for everyone

Maggie’s House centres offer support to anyone with cancer or their loved ones.  Support offered includes: 

• Cancer support specialist available.
• Pilates.
• Benefits advice and support.
• Choir.
• Tai Chi.
• Managing stress course.
• Fitness sessions.
• Relaxation sessions.
• Where now post treatment course.

Maggie's | Everyone's home of cancer care

This group helps patients and families dealing with effects of breast cancer. Meetings are at 19:00 on the first Tuesday of each month at:

BAWA club, 
589 Southmead Road, 
Bristol,
BS34 7RG. 

• Guest speakers.
• Monthly lunches – at Penny Brohn.
• Complementary therapies – a place to treat yourself and recharge.
• Workshops – wellness days throughout the year covering different and useful topics. 

Home - Bosom Buddies Bristol

Keeping Abreast – Keeping Abreast - Breast Cancer Reconstruction Support

Flat Friends – Flat Friends UK

Coppafeel! – CoppaFeel! | Check Your Chest | Breast Cancer Awareness Charity

Shine. For women under 45 – Home | Shine Cancer Support

The centre provides information and support around cancer including:

• Information leaflets.
• Advice and support.
• Relaxed area to have refreshments and talk.
• Information and support groups.
• Quiet rooms for one-to-one support.
• Care planning with a Macmillan Cancer Support Worker.
• Health and wellbeing events.
• Breast prosthesis fitting.
• Physiotherapy.
• Dietitian.
• Psychological support.
• Benefits advice.
• Complementary therapies.
• Arts on referral.

My Medical Record is a free and secure website where you can access information about your post cancer treatment follow-up, access to information resources and message centre.

If you would like access to My Medical Record or have any questions, please contact: BreastMMR@nbt.nhs.uk

At the end of your active treatment, you will receive a treatment summary from your consultant. A copy will also be sent to your GP. 

Following this you may be offered a Cancer Care Review by the GP Practice.

Although you have the continued support of the whole team at Southmead, this page also shows you what other support there is out there. 

Breast Cancer Now

We're Breast Cancer Now | Breast Cancer Now

Fix or Replace enhancing distal humerus fracture

A broken elbow is a common injury, particularly amongst older people. If the bone is badly broken, recovery is difficult, and people often suffer with pain and stiffness even after the break has healed. It is important that we offer people the best chance of making a full recovery.  

The clinical trial is looking at the cost effectiveness of elbow arthroplasty undertaken for distal humeral fractures in older patients when compared to open reduction and internal fixation. 

PI: Alisair Bott 

Start Date: 17/10/2025 

End Date: October 2027 

Local Ref: 5721 

Thromboprophylaxis in lower limb immobilisation

A study comprising two liked open label Phase lll randomised controlled trials evaluating the effectiveness and cost effectiveness of different methods of pharmacological prophylaxis for patients with temporary lower limb immobilisation. 

Venous thromboembolism (VTE) is a major global health burden. Many people who survive VTE suffer from longer physical complications or psychological sequelae. Temporary lower limb immobilisation (Plaster cast, walking boot or rigid splint) and injury are combined risk factors for VTE. Approximately 70.000 people are immobilised after injury every year in the UK. VTE in this setting is potentially preventable through early prophylaxis with anticoagulant medication. However, baseline VTE risk varies widely across the population and there are multiple drugs for prophylaxis, including Direct oral Anticoagulants (DOACs) and parenteral therapies. There is no high-quality evidence comparing different methods of pharmacological thromboprophylaxis for patients at high risk of VTE and limited evidence of the benefits and risks of any prophylaxis for patients at low risk of VTE. 

PI: Nick Adams and Michael Kelly

Start Date: August 2025

End Date: November 2027

Local Ref: 5560

This study will compare two different ways to help people with their recovery from a broken shoulder. Patients with this injury are usually referred for physiotherapy appointments for advice on how to get their arm and shoulder working again

In this study, patients will be asked to follow one of two rehabilitation programmes. They will either be offered:  Outpatient physiotherapy appointments to be shown what exercises to do or advice and information about a self-directed exercise programme that can be done at home. Advice will be given by a health professional in the hospital clinic, and you will also be given a high-quality workbook to help guide your recovery. 

PI: Rhian Witham 

Start Date: Jan 2025

End Date: Dec 2026

Local Ref: 5639

Peri-Op Iron and Erythropoietin (EPO) Intervention Study 

Anaemia after major emergency surgery in older people with hip fractures is common and is associated with increased mortality, longer length of hospital stay and poorer quality of health. The POP-I trial aims to recruit patients 60 and over, who are anaemic in the postoperative period following either hip fractures. Participants who give their consent will be assigned randomly into one of three study groups: Usual care, Iron Infusion, or iron infusion and an injection that will stimulate red blood cell production.

PI: Katherine Walsh 

Start Date: Nov 2024

End Date: 31/12/2026

Local Ref: 5535

This study aims to find out the best treatment for patients 16 years and over with repeated dislocations of their kneecap (patella). The study is comparing personalised knee therapy, delivered by a Physiotherapist, to surgical stabilisation for improving patient function following repeated dislocation.

Project Details:

PI: Mr Damian Clark

Start Date: Dec 2023

End Date: 31/10/2025

Local Ref: 5440

This study compares surgery to sling immobilisation in the management of adults with a displaced fracture of the distal clavicle (Collarbone) in patients over the age of 18 years old with 21 days of injury. 

When the outer end of the collarbone has broken, parts of the bone may separate and not line up. This can rupture the ligaments connecting the collarbone to the shoulder blade. Doctors commonly treat this type of injury that have had with: A sling, to help support the shoulder while the bone heals naturally; or surgery that uses metal work to try the separated bone while they knit together naturally.  Both treatments work but we do not know which one works the best. The aim of this study is to find this out. 

Project Details:

PI: Iain Packham 

Start Date: December 2023

End Date: 31/3/2026

Local Ref: 5405

Distal Radius Acute Fracture 3: Cast verus Splint; a randomised non-inferiority trial comparing clinical and cost-effectiveness of a standard cast versus removable splint in Adults with a distal fracture tat does not require Manipulation.

When a person breaks their wrist, the treatment usually involves a support for the injured wrist. This support provides pain relief. It also protects the fracture (the break) whilst it heals.

In most hospitals in the UK, people with a broken wrist are given a plaster cast. After 4 to 6 weeks, they go back to hospital to have the cast taken off.

The results of a recent research study show that a removable wrist splint might provide the wrist with the same amount of support as a cast.

The benefit of this is that you can take it off yourself at home, so you don’t need to have it removed at a hospital. This could be more convenient for you. Providing people with a splint instead of a cast might also save money for the NHS.

At the moment, doctors, physiotherapists and other healthcare professionals are not completely sure if having a splint gives the same level of pain relief and support as a cast.

In this study, we will directly compare people receiving a cast with people receiving a splint for treating broken wrists. We want to find out if levels of pain and the ability to do everyday tasks are similar between the two groups. We will also have a look at the cost of both treatment options to the NHS, and society as a whole.

Project Details:

Principal investigators: Alasdair Bott and Fran Verey

Start date: 03/2023

End date: 30/11/2025

Local ref: 5350

Lidocaine Intravenous Trial

A broken hip is a very serious injury that requires surgery to repair or replace the broken bone followed by a period of recovery in hospital. Around a quarter of patients who have a hip fracture have an episode of ‘delirium’ following surgery. Delirium is a condition where the patient loses awareness of themselves and the environment, and has difficulty thinking clearly. Inflammation, caused by the hip fracture and by the surgery to repair the hip, is thought to be the root cause of delirium. 
This study investigates the use of a drug called ‘lidocaine’ to see if it reduces the risk of delirium during surgery for a hip fracture.

Project Details:

Principal Investigator: Dr Paddy Morgan

Planned end date: June 2025

Local Ref: 5120

Fix or Replace Undisplaced Intracapsular fractures Trial of Interventions (FRUITI).

Patients who sustain hip fractures that involve minimal displacement of the bone fragments may be treated surgically with either replacement of the hip joint of fixation of the fragments. The study is randomly allocating patients with these types of fracture to either type of surgery. Patients will be monitored up to 12 months post surgery.

Project Details:

Principal Investigator: Mr Tim Chesser
Planned End Date: 31/01/2029
Local Ref: 4695

ACL Starr-UK

Anterior Cruciate Ligament Stratified Accelerated Repair or Reconstruction Single blind randomised controlled trial for patients with proximal ACL injuries treatment with ACL repair v ACL reconstruction (ACL STARR).

When people decide to have surgery to fix a torn ACL, there are two options:

One is very commonly used and is tried and tested. This is called a ‘reconstruction’, which means that the torn ligaments is replaced using tissue from elsewhere in your body.

The other is called a ‘repair’ which means that your torn ligaments is kept and repaired. Not every ACL tear is suitable for repair. The study is looking at comparing these two different types of surgery to see if one is better than the other. Participant and physio blinded to the treatment allocation.

PI: James Murray

Start Date: 17/06/2025

End Date: 30/06/2027

Local Ref: 5717

A prospective multi-centre cohort series of INFINITY with ADAPTIS and EVERLAST technology with Poly insert for patients requiring primary total ankle replacement (TAR) i.e Total Ankle Arthroplasty.

AN ankle replacement procedure consists of replacing the warn-out joint surface of the ankle with metal and plastic components that are shaped to allow continued movement of the ankle. There are several different types of ankle replacement available. Infinity ankle replacements are already used in NHS hospitals. The INFINITY with ADAPTIS and EVERLAST ankle replacement system is a development of the infinity ankle implant, designed to attach to the bone better and to wear out more slowly.

PI: Steve Hepple

Start Date: 02/09/2024

End Date: 09/2030

Stability 2: ACL reconstruction +/- Lateral Tenodesis with patellar Vs Quad tendon, is an international, multicentre randomised clinical trial which is recruiting young active ACL deficient patients. ACL rupture is one of the most common musculoskeletal injuries in young individuals, particularly those who are active in sports. This trial is looking at quadriceps and patellar tendon grafts, as well as lateral extra-articular tenodesis, to see which combination gives the best result for young athletic individuals who are at high risk of ACL re-injury.

PI: James Robinson/Nick Howells
Start Date: 08/07/2025
End Date: 30/06/2027
Local Ref: 5045

The clinical and cost-effectiveness of elective primary total knee replacement with PAtellar Resurfacing compared to selective patellar resurfacing. A pragmatic multicentre randomised controlled Trial with blinding.

Total knee replacement (TKR) is commonly used for treating severe arthritis, with over 100,000 performed annually in the UK. During TKR, surgeons can resurface the patella (replace the under surface of the kneecap with a plastic prosthesis) or leave the native patella to articulate with the femoral implant. Resurfacing the patella is initially more expensive (longer theatre time, higher implant cost, risk of additional post-operative complications), but in the long-term it can reduce the risk of on-going pain which can result in further surgery to resurface the patella. NICE recommends always resurfacing the patella rather than never doing so. NICE did not find sufficient evidence on selective resurfacing (intraoperative decision based on the state of the patellar surface and the patients' symptoms) to make a recommendation on that strategy, but did recommend specific research was conducted on this question. If effective, selective resurfacing could result in optimal individualised patient care. This study evaluates the clinical and cost-effectiveness of elective primary TKR with always patellar resurfacing compared to selective patellar resurfacing.

Project Details:

Chief Investigator: Ashley Blom

Principal Investigator: Sven Putnis

Planned End Date: 31/03/2026

Local Ref: 4999

Hip Implant Prosthesis Programme for the Younger total hip replacement patient.

Over 100,000 hip replacements are performed each year in the UK. Around 90% of patients report good pain relief and mobility after surgery, and most implants last 25 years or more.

Primary hip replacement involves replacing a damaged hip joint with an artificial implant that has two main parts. One part goes into the leg bone and ends in a ball which fits into a socket or cup attached to the pelvis, making a ball-and-socket joint. Implants can be fixed to bone with cement (cemented), without cement (uncemented), or partially cemented (hybrid). Cost ranges from £500 for some cemented to £2,000 for some uncemented implants.

When an implant fails, for example due to loosening or wear, it has to be re-done. Revision is a major operation, typically costing the NHS over £10,000. Cemented hip implants are safe, inexpensive, have a long track-record, and offer the best value-for-money for men aged over 75 and women aged over 65 years. There is no high-quality evidence to suggest more expensive uncemented or hybrid implants are any better than cemented implants for younger patients. Yet three quarters of NHS patients aged under 70 years receive uncemented or hybrid implants.

This Programme of research aims to find out which hip implants are best for patients under 70 years of age.

Project Details:

Chief Investigator: Elsa Marques

Principal Investigator: Mike Whitehouse

Planned End Date: 01/07/2031

Local Ref: 5258, 5259

This is a commercial study reviewing progress of patients who have undergone total hip replacement surgery using the Furlong short stem implant. The potential benefit for using a short stem implant is that it aids early mobilisations and preserves the femoral bone should further surgery be required.

Project Details:
Principal Investigator: William Poole
Planned End Date: 30/09/2027
Local Ref: 3275

A commercial study involving review of patients treated with an INFINITY Total Ankle Replacement. The study is collecting clinical and patient reported outcomes up to 10 years following surgery.

Project Details:

Principal Investigator: Mr Steve Hepple
Planned End Date: 31/12/2029
Local Ref: 4168

This study aims to compare two different plates currently used in knee realignment surgery (high tibial osteotomy). The purpose of the metal plates is to maintain the correct realignment achieved at surgery whilst the bone heals. The two plates, TomoFix and ActivMotion are both used in current practice and comply safety regulations.

Once the knee correction has healed (approx. 12 months) the plate can be left in. Some patients may however experience discomfort that related to the plate and benefit from plate removal ,  about a year after their initial operation. The ActivMotion plate design is a smaller than the Tomofix and it is therefore potentially less likely to cause discomfort . It is anticipated that second operations for plate removal will be less frequent than for the Tomofix plate.

In this study we would like to compare the number of plates that need removal following surgery, assess pain levels in patients in the first two years following surgery and compare the amount of pain relief used in the immediate post-operative recovery period.

Participants will be asked to complete a questionnaire before they have their operation and twelve months after the operation to assess their pain and function. This information will be used to compare the outcome of the plates.

Project Details:
Principal Investigator: Mr James Murray
Planned End Date: 01/10/2027
Local Ref: 3810

This study is a prospective, post-market, global, multi-center, non-controlled, observational clinical evaluation of the commercially available Persona® Partial knee implant. The primary objective of the study is to obtain survivorship data and assess clinical performance (outcomes) using outcome measurement tools (e.g. patient questionnaires), radiographic assessments and adverse event data.

In total, there will be 30 global sites in the US and Europe. In the UK, the multi-centre study is being conducted at four sites in England with a maximum of 40 patients at each centre. Male and female individuals aged 18 years and over, with a confirmed diagnosis of osteoarthritis and who qualify for unicompartmental (partial) knee surgery will be potentially eligible to take part. Each Investigator will offer study participation to each consecutive eligible patient who satisfies the Inclusion/Exclusion criteria for partial knee arthroplasty using the commercially available Partial Persona Knee.

Following completion of the informed consent process, participants will undergo preoperative clinical evaluations prior to their partial knee arthroplasty. Patients will then be asked to attend post-operative follow-up clinic visits at 3 months, 1 year, 2 year, 5 year and 10 year. At these follow-up visits, clinical and radiographic evaluations will be conducted.

Project Details:

Principal Investigator: Mr Andrew Porteous
Planned End Date: 31/12/2028
Local Ref: 3905

Hip replacements are a very common operation for people with painful arthritis. However, sometimes these hip replacements need to be done again because of pain and loosening.  We think that similar things may lead to loss of bone density (thinning of the bones) and loosening of joint replacements.  Because of this there is concern that loss of bone density may increase the need for further surgery to correct the loose joint replacement.

The study aims to see if there are differences in bone density and other factors that may explain why some people need their hip replacements done again (revised) and some do not.

Project Details:

Principal Investigator: Dr Emma Clark
Planned end date: 31/12/2025
Local Ref: 2503

 Reverse or Anatomical replacement for Painful Shoulder Osteoarthritis, Differences between Interventions (RAPSODI): a multi-centre, pragmatic, parallel group, superiority randomised controlled trial. 

Patient aged 60 years or over with painful OA of the shoulder and an intact rotator cuff presenting to secondary care and through shared making, having completed non-surgical treatments, proceeding to shoulder replacement. In shoulder replacement surgery, doctors remove the damaged parts of the shoulder and replace them with plastic or metal parts. 

The RAPSODI-UK study compares two types of shoulder replacement: the Total shoulder  replacement, and the Reverse Shoulder replacement.  These are the two types of shoulder replacement that NHS doctors use most often for patients with arthritis who need a shoulder replacement.  

They both help to reduce pain, and maintain or improve movement. However, doctors genuinely don’t know yet which one works best. 

 Project Details:

Principal Investigator: Mr Mark Crowther  

Planned end date: 04/2026

Local Ref: 5267 

Evaluation of safety and efficacy of a resorbable collagan IMplant in treatment of High Grade PArtical thiCkness Tear; A prosepctive, mulitcentre, randomized, control trial.

Patients who are 18 years and over, with a partial rotator cuff injury who’s symptoms persist following 3-6 months of conservative treatment are eligible for this study.

Impact study compares two types of surgery:

The rotator cuff is a group of muscles and their tendons that act to stabilize (hold in place) the shoulder. Torn rotator cuff tendons are common injuries that result in shoulder weakness and pain. These injuries can be treated with medications, injections, and physical therapy. However, when symptoms continue despite these treatments, surgery is often recommended to repair the injured tendon. An alternative to standard surgical procedures for repairing torn rotator cuff tendons involves applying a protective layer of collagen over the injured tendons to aid in healing and stop disease progression. Collagen is the most commonly found protein in the body and is present in the skin, bones, tendons and ligaments. The collagen is extracted from bovine Achilles tendons (from cows).  

The purpose of this study is to find out if the marketed REGENETEN™ Bioinductive Implant is better than standard repair techniques for surgically treating partial-thickness rotator cuff tears. Smith+Nephew is the company paying for the study and REGENETEN is one of their products.

Project Details:

Principal investigator: Iain Packham

Start date: March 2023

End date: June 2026

Local ref: 5311

Tailored physiotherapy Rehabilitation after revision total hip replacement

Hip replacement surgery is usually a success. However, some people will need another surgery on their hip. This is called revision surgery. After revision surgery, people often need to stay in hospital longer and may find it difficult to get back to activities they did before. We know a lot about how to help people recover after their first hip replacement, but we do not know enough about the best way to help recover after revision surgery.

We want to compare two types of physiotherapy for revision surgery: (1) comprehensive physiotherapy designed around the patient that includes exercise and education, and (2) physiotherapy that a patient would routinely get after surgery 

PI: Emma Kislingbury 

Start Date: 3/10/2025 

End Date: 31/05/2026 

Local Ref: 5812 

Steps

1. Start taking insulin every night. We will tell you how much to start with.
2. Check your fasting blood glucose in the morning.
   1. If below 5 go to step 3.
   2. If above 5 go to step 4.
3. Continue with current insulin dose. Go to step 2.
4. Increase insulin by 4 units at night. Go to step 2. 

DBS is the main surgery used to treat Parkinson’s. It is a well-established treatment which has been used since the 1990’s. The DBS service for Parkinson’s was set up in Bristol 25 years ago. It is one of the largest centres in the UK, treating around 60 new patients every year.

DBS is most effective at improving motor symptoms, such as tremor, slowness of movement, stiffness and dyskinesia. DBS is not a treatment for the non-motor symptoms of Parkinson’s, but it may improve some of them, such as sleep.

How is the device implanted?

In Bristol, this is done under general anaesthesia (you are asleep) with robotic assistance.

• Your head is put in a metal frame to keep it still in the robotic arm.
• Two small holes are drilled in the front part of the skull.
• Small thin tubes called guide tubes are put through the two holes into the brain.
• Thin wires called electrodes are implanted through the guide tubes into the target area in the brain.
• The electrodes are attached to the connecting wires (extension leads). These are placed under the skin and connected to a small battery (similar to a cardiac pacemaker). This is placed beneath the collar bone in a chest pocket.

You will be discharged a day or two after the surgery and return in 4-6 weeks to have the DBS activated once you have healed.

When the pulse generator is switched on, the electrodes stimulate the targeted area in the brain. The stimulation alters signals in the brain to improve the symptoms of Parkinson’s. Over the next 2 years you will have several follow-up visits to adjust the stimulation and your medication.

DBS therapy doesn’t stop your Parkinson's progressing over time. Having DBS may mean you can reduce your Parkinson’s medication by up to 40%, although this is different for each patient. All the DAT options can be useful for people with motor fluctuations, but DBS is the only option that is helpful directly for tremor.

What are the risks?

Like all surgery, there are risks with DBS surgery which include and are not limited to:

• Small risk of infection, especially in the first month. If this happens, you may need to have the DBS removed. You may need to stay in hospital for antibiotics.
• Rare risk of bleeding in the brain.
• Problems with speech and balance, which may improve with re-programming the device.

Who can have DBS?

If you are thinking about DBS, you will have a series of tests to see if you’re suitable for this type of surgery. This may be a day-case or overnight stay and is done by a specialist team, including a Neurologist and DBS Nurse. During the assessment, surgery, and follow-up, you will need to make lots of visits to Southmead hospital. You should think about this when making your decision.

Certain people cannot have DBS, for example if you have a cardiac pacemaker or if you cannot have an MRI scan. Also if you have significant balance or memory problems, then DBS is not suitable. Instead, you may be able to have one of the other therapies on the next few pages.

Apomorphine is a type of dopamine agonist, like other drugs such as ropinirole, pramipexole and rotigotine. Apomorphine is given subcutaneously (under the skin) using a small plastic cannula connected to a pump. Despite its name, apomorphine is not related to morphine and is not addictive.

Apomorphine can be given in two ways:

1. Intermittent injections or “rescue therapy” with and injector pen.
2. Continuous infusion using a pump.

Apomorphine can improve movement symptoms within 5-10 minutes. The effect of a single injection usually lasts for about an hour.

Some patients use injections every so often, whilst others need a continuous infusion. Apomorphine infusions are usually given throughout the day but can also be continued overnight in some patients. Apomorphine does not replace most other Parkinson’s medications and needs to be used with them. The infusion must be set up daily and you will be given training and ongoing support with this by a specialist nurse.

Who can have apomorphine?

If apomorphine is being considered, your Parkinson’s specialist will usually refer you to your local apomorphine nurse. You can discuss the therapy in more detail and sometimes arrange a response test. This is done to see if you respond well to the treatment and to check if you have any side effects. You will need to have an ECG and blood tests before the response test.

Your Parkinson’s specialist will not recommend apomorphine if you have problems with low blood pressure, hallucinations, or psychosis, as these can be made worse by the treatment. It may also not be recommended if you have had certain side effects from other dopamine agonists, including impulsive behaviour.

Nausea and vomiting are common side effects when starting apomorphine. An anti-sickness medication (domperidone) is prescribed at the beginning to help with this. Another common issue can be skin reactions, particularly with continuous infusions but these can usually be managed with advice from your apomorphine nurse.

Apomorphine pump

Pen for size reference. 

Apomorphine pen

Pen for size reference. 

Duodopa is a gel form of the drug levodopa (the main treatment for Parkinson’s). It is delivered directly into the small intestine via a small pump.

This treatment is given through a tube called a gastrostomy or PEG-J tube which needs to be inserted to deliver the gel medication. Patients starting on LCIG are usually admitted to hospital for around 5 days, which allows the gastrostomy tube to be put in. The medication is then started and adjusted to control symptoms. This is overseen closely by a specialist team, including a neurologist and specialist nurse.

The treatment usually runs through the day and replaces most tablet medication for Parkinson’s, except those used overnight. The pump needs to be set up daily and often people need support with this. For some patients, an overnight pump can be added to treat symptoms at night.

We will usually only recommend Duodopa if DBS or apomorphine are not suitable.

What are the risks?

• When the PEG-J is inserted there can be infection and bleeding.
• When the treatment has started there can be:
  • Infection around the tube.
  • The tube can be blocked or move out of place which stops treatment working. This may mean you need to take tablets again until the tube is unblocked or or replaced (you may need to stay in hospital).
• You may develop a B12 deficiency when taking Duodopa. We will give you a B12 supplement to stop this. 

If you are thinking about LCIG, you will first need some tests to see if you’re suitable. This may be a day-case or overnight stay and is done by a specialist team, including a Neurologist and Specialist Nurse.

LCIG pump 

Pen for size reference.

Lecigon is another form of levodopa gel treatment. It is similar to Duodopa but has an additional drug called entacapone. This makes the levodopa work for longer. Lecigon became available for the treatment of Parkinson’s in the UK in 2025, but it has been used for several years in other countries.

Like Duodopa, Lecigon requires insertion of a gastrostomy tube. This allows the gel medication to be given directly into the small intestine via a pump. Because the entacapone is added, a smaller amount of gel is needed to control symptoms. This means the pump is smaller and more portable.

What are the risks or side effects?

• Diarrhoea – this may mean you cannot use Lecigon. You may need a trial of entacapone tablets first to see if you can tolerate this,
• When the PEG-J is inserted, there can be infection and bleeding.
• When treatment has started there can be:
  • Infection around the tube.
  • The tube can be blocked or move out of place which stops treatment working. This means you may need to take tablets again until the tube is unblocked or replaced (you may need to stay in hospital).
• You may develop a B12 deficiency when taking Lecigon. We will give you a B12 supplement to stop this.

We will usually only recommend Lecigon if you are not suitable for DBS or apomorphine.

If you are thinking about Lecigon, you will first need some tests to see if you’ are suitable for this type of treatment. This may be a day-case or overnight stay and is done by a specialist team, including a neurologist and specialist nurse.

LECIG pump

Produodopa is a new treatment for Parkinson’s and was approved by for use in the UK in 2024. Produodopa is a liquid form of levodopa (the main treatment for Parkinson’s) and is given subcutaneously (under the skin), using a pump, the same way as apomorphine.

This pump treatment runs for 24 hours a day to control motor symptoms both during the day and night. This means you will need to wear the pump day and night. Produodopa will usually replace most of your other Parkinson’s medications.

If you are thinking about Produodopa, your Parkinson’s specialist will usually refer you to a Produodopa nurse. You can discuss the therapy in more detail and they will show you how to use the pump. You will also have a series of tests to make sure you are suitable for the treatment.

The treatment can be started either during a short stay in hospital (average 2 days) or as a day-case. You will need several visits to adjust the dose after starting treatment, so it is important to be prepared to attend the hospital often in the first month.

What are the risks or side effects?

As this is a new treatment, we are still developing our understanding of the risks/ side effects and benefits of Produodopa. A common issue from clinical trials has been skin reactions, including swelling, inflammation and skin infections. These can be managed with advice and training by Produodopa nurses. Another common issue we have found is difficulty finding the right dose of medication, which is why you may need to come to hospital more often than with other DAT.

We will usually only recommend Produodopa if you are not suitable for DBS or Apomorphine.

Produodopa pump

Frozen shoulder affects about 2-5% of people and commonly occurs in people aged 40-70. Between 6-17% of people with frozen shoulder, go on to develop it in the other shoulder, within five years of their first episode.

• Pain that limits your full range of movement. Pain often interferes with sleep.
• Joint stiffness, which limits your range of movement and daily activities.

Symptoms might become gradually worse over a number of months or years. See the stages below for more details.

These symptoms can make your everyday tasks frustrating and challenging. For example, you will likely have difficulty getting your hand behind your back for a long period of time. This movement is one of the last movements to return when you are in recovery from frozen shoulder.

The symptoms can vary over time in severity and overlap. To help guide treatment we may classify your symptoms into 2 phases:

1. Painful predominant phase - where pain is the main problem and may interfere with your sleep.
2. Stiffness predominant phase - where the stiffness or lack of movement is the main problem.

Recovery rates vary and usually last 2-3 years. However up to 40% of people can have symptoms for more than 3 years.

It is not clear what causes frozen shoulder, but there are many factors which put someone at higher risk. These include:

• Diabetes (type 1 or 2): 10-20% of people with diabetes develop frozen shoulder.
• Other conditions: hypothyroidism and hyperthyroidism, cardiac disease, Parkinson’s.
• Previous shoulder injury or surgery.
• Dupuytren’s contracture.
• Previous frozen shoulder. 

Most people with frozen shoulder will eventually get better. However, there are treatment options that can reduce pain and improve the movement in your shoulder.

The type of treatment will depend on your specific situation. It will also depend on whether the pain or stiffness limits you more.

• During the painful stage, the emphasis will be on reducing your pain.
• During the stiffness stage, the emphasis will be on improving your range of motion.

Next we will discuss hydrodistension injection which is one of the treatment options for stiffness.

• Take your normal pain relief one hour before the injection
• Inform the Radiology department if you:
• Are pregnant.
• Have diabetes.
• Feel unwell.
• Have an infection, cold, or persistent cough.
• Have any allergies.
• Are taking any of the following medications:
  • Antibiotics, aspirin, warfarin or clopidogrel or any other tablet to thin the blood (some of these may have to be stopped some days before). 

You will lie on your back, with your arm (frozen shoulder) out to the side. The skin will be sterilised and the local anaesthetic will be given. This will numb the area.

Using an X-ray, a fine needle will then be inserted into the joint. A small amount of X-ray dye (iodine contrast) will be injected into the joint to make sure we have found the best position for the needle. Once in the best position, 15-40mls of a mixture containing more local anaesthetic, steroid, and fluid (saline) will be injected into the shoulder.

You may feel some pressure and pushing. If you do feel discomfort please tell the radiologist.

General risks:

• Allergic reaction to the steroid, which may be life threatening (anaphylaxis).
• Bleeding.
• Infection: if the injection area becomes red, hot, and swollen and you feel unwell, seek help immediately.

For steroid injections

• Skin thinning, dimpling, and change of skin colour at the site of the injection.
• Facial flushing for a few days.
• Occasionally symptoms may get worse for couple of days. You can take your painkillers if you need to.

This list does not cover everything. If there are further risks or complications your consultant will tell you these before the injection.

Pain and discomfort

You may feel some moderate pain and discomfort following the injection. This typically lasts less than 30 minutes.

You will stay in the department for 15-30 minutes after the injection and then you will be discharged home.

A numb sensation in the shoulder is normal from the anaesthetic and this often lasts around eight hours. You should not drive the day of your injection; your insurance may not cover you. It is your responsibility to call your insurance company about driving after the injection.

If you have diabetes

Closely monitor your blood sugars after the procedure for 48 hours. Your insulin requirement may increase due to the steroid.

You will need to be monitor your glucose levels for 1 month after the injection. If you have any issues managing your diabetes, speak with your diabetes specialist nurse or see your GP.

Will my symptoms come back?

Research shows that 7.8% of people’s frozen shoulder may come back and may need another injection.

1. Pendulum - do this 10 times clockwise, 10 times anticlockwise. Let your arm hang, relaxed straight down. Gently swing your arm as if drawing a circle. Change direction. 

   

2. Using a broom for external rotation. Do this 10 times. Sit with both elbows at right angles. Hold a stick with both hands. Push the stick to rotate the arm outwards as far as comfortable. Keep your elbows by the side of your body as shown. 

   

3. Climbing up the wall with fingers and supporting the affected arm. Do this 10 times. Stand facing a wall. ‘Walk’ your fingers up the wall as high as comfortable. ‘Walk’ your fingers back down again. 

   

4. Using the kitchen table and walking away stretching the arms and shoulders. Do this 10 times. Standing. Hold onto a table, slowly walk backwards, moving your body away from your hands.

   

5. Using a towel to pull up the arm to the mid back (bra strap). Do this 10 times. Stand or sit. With one arm, bring a towel/belt over your shoulder, behind your back. Hold onto the towel with the affected arm. Gently pull up, bringing the lower arm up. your back as able. Hold 5 – 10 seconds.

   

Information on adhesive capsulitis

• Adhesive capsulitis - Symptoms, diagnosis and treatment | BMJ Best Practice
• Adhesive Capsulitis of Shoulder - DynaMed
• Frozen Shoulder - Adhesive Capsulitis - OrthoInfo - AAOS
• Arthrographic distension for adhesive capsulitis (frozen shoulder) - Buchbinder, R - 2008 | Cochrane Library