Alan

Age at interview: 63

Brief Outline:

For about twenty years, Alan experienced recurrent shoulder pain that has been treated with steroid injections and physiotherapy. Recently, the pain became severe when he did any rotatory movement, or when lifting his arm. At his assessment meeting with the consultant, he was given the option to continue having steroid injections or to have surgery. He opted to have sub-acromial decompression surgery. The operation went well and he has regained much of the movement and flexibility in his arm and shoulder.

Background:

Alan is married and has two adult children. He is a librarian and works full-time. Ethnic background: White British.

More about me...

Alan’s shoulder problem started around twenty years ago and he thinks that it might have been caused by his sports activities. He used to play lots of squash and badminton, but stopped due to his shoulder pain. At the time, he saw his GP and had steroid injections and physiotherapy, which helped controlled the pain for long periods of time. More recently, however, any kind of shoulder rotatory movement or movement that involved lifting his arms became very painful. 

Alan works as a librarian and about three years ago, he was dealing with an old and heavy rolling bookcase and injured his bad shoulder. He was seen by occupational health and by his GP. At his GP surgery, he had two steroid injections: the first one helped to relieve the pain, but the second one didn’t work. Then, his GP referred him to the Nuffield Orthopaedic Centre, an NHS hospital where he had another steroid injection which helped with the pain for a few months as well as having physiotherapy. He had an X-ray and was invited to attend the assessment clinic at the hospital. The shoulder specialists he saw explained his treatment options: to continue having up to three steroid injections per year or to go for sub-acromial decompression surgery. Alan chose to go ahead and have surgery. He says there was never any pressure on him to have surgery and everything was explained thoroughly by the consultant. He had never had an operation before or general anesthetics, so the prospect of surgery was a bit scary.

Three weeks after seeing the consultant, Alan went back to have his operation. Afterwards, the surgeon told him that the surgery had gone smoothly and that the bone spur had been removed without any problem. He says that he was well impressed by the level of care he received and by the quick and well-structured system they had in place. 

After his operation and once the effects of the nerve block wore off, he gradually began to get his shoulder movement back and after a week he was already able to lift his arm. Alan went back to work three weeks after his operation and explained to his boss what he could and couldn’t do at work, and they were fine with it. Besides, he says that his work colleagues are supportive and willing to give him a hand if and when he needs it.

Alan has used the Technology Enhanced Patient Information (TEPI) site during his rehabilitation period. He found the visual format of the exercises engaging and reassuring. The physiotherapist was well pleased with his progress at his post-op follow-up appointment. He found the TEPI site most informative and in turn, he became curious about finding more information on the web about sub-acromial decompression surgery. Based on his own experience, he feels that TEPI can do with providing practical information on how to manage life at home when still under the effects of the nerve block. Things he found problematic were to do with getting out of the bath, hanging the washing up and managing the loo with just the one functioning hand.

Alan was given a choice of cortisone injections or surgery. He was sceptical about having another injection and more physio, so opted for surgery.

I saw one of the doctors and we decided to try a steroid injection, which worked for like a few months again and then it wore off. And then I think I got a letter through saying it was one of those, like your next appointment is like a meeting with a doctor. But I think it’s [consultant’s name], as an assessment meeting. That’s when he started to talk about the op. “If you don’t want that, you can have, you can come here three times a year and have steroid injections and we’ll try some more physio. Or, you know, try this op if you want to. It’s quite successful.” So that’s when I said, “Okay, let’s try the op.” 

What was it that made you decide to go for the operation?

Well, I think, I think, yeah looking back it’d been, you know, a long time and the prospect of going in three times a year for a steroid injection and more physio. Was it actually going to do any good long term? 

I think he said the success rate on this op was about 85 or something per cent. So it’s quite, it’s quite a good success rate. And looked at some of the things that might go wrong, like a frozen shoulder or stuff like that, you know. And so it seemed the right thing to do really. So I said, “Okay let’s go, go for it.”

The consultant explained the success rates and risks, including frozen shoulder. Alan chose to have surgery and his name was put on the cancellation list.

He [consultant] said the success rate on this op was about 85 or something per cent. So it’s quite, it’s quite a good success rate. And looked at some of the things that might go wrong like a frozen shoulder or stuff like that, you know. And so it seemed the right thing to do really. 

So I said, “Okay let’s go, go for it.” And then when I got outside I realised I actually had never had an op before so, or a general anaesthetic. So I thought um... But, yeah, so that was the only scary bit for me because I’d never had an op or a general before.

What was it that you were scared of at that point?

Well, I suppose the unknown, you know, I’ve never, never had an op before. Didn’t know what was going to happen or am I going to come round? That sort of thing. It’s a bit stupid, isn’t it [laughs]? 

No, no. Not at all. 

Am I ever going to wake up again [laughs].

Yeah. Did the doctor tell you much about the operation during that?

Yeah, yeah. So that was, I think it’s [consultant’s name]. Yeah, I mean he talked thoroughly through it. Talked about the success rates and things like that. There was never any, I don’t think, there was no pressure to have the op. He was quite happy for me to go back, you know, three times a year and have the steroid injection if I wanted to. But he said that’s it’s something that they do lots of. So it’s pretty routine and the success rates seem good. 

And he said if I wanted to I could go on like a cancellation list. So it could be quick, which fitted with work as well because I think it was like three weeks off work afterwards. So you know, that could be a problem for some people. But for me at, now at this time, it worked quite well.

The exercises in visual format were very useful and Alan did them every day. He watched videos on YouTube of the actual surgery.

Were you told to do any exercises?

Yeah. When I left the hospital it was basically follow those TEPI physio exercises that are on the, on the, is that the TEPI? 

Yeah, it’s a video. 

Yeah. Yeah, so I just followed those, which, I was good, every day I was really trying to do them and I found them very useful, especially in that visual format, you could actually see, you know, what you’re supposed to be doing. I think if you go for physio and then you go away and think, you can forget certain bits of it or what position you actually should be in, you know. So I found that really useful that bit.

Did you look for information anywhere else? Was there anything you wanted to know once you’d got home?

I did become curious, you know, because I looked at the TEPI stuff. So I had a go on YouTube. Saw a few bits and pieces. Saw some live ops and people having it done. 

Oh really.

But you actually couldn’t see a lot because they’d got the patient covered up, completely covered, just the shoulder sticking out. The surgeon was describing what he was doing. But yeah, it was quite interesting. It didn’t bother me. And then yeah I went on to like on to the Internet and just read a bit about the procedure. There was quite a lot of information that popped up from other hospitals as well that carry out the same kind of procedure. So that was, is quite interesting

Doing everything with one arm was hard in the first few days. This included going to the toilet, getting out of the bath and reaching things in high places.

The only thing was the after bits, like when I said about, you know, only having one hand, one arm, and doing something without thinking about it. Maybe they could talk more about that perhaps, like going to the loo, you know that’s like a problem if it’s your proper arm. You know, if it’s not, then it’s fine, but if it’s that one. 

Or I can remember being at home going to get something out of a cupboard and thinking I can’t reach the cupboard, and realised my arm was in the way. I couldn’t feel it. So maybe that possibly for those couple of three first days. Because you know I jumped in, because I can remember them saying you shouldn’t be on your own for the first day after the op, which was okay. But the second day I thought, “Oh, I’ll be fine.” You know, that’s when I got in the bath and I was on my own and I thought, “Oh God, how do I get out?” So, it might be worth a bit more information about that side of it. I think the rest of its fine. 

Alan had a checklist of tests to have and professionals to see, which was ticked off as he went along. It was well timed, structured and informative.

The Nuffield [NHS hospital] seems to be really good at being on time with their appointments. And I can remember going in, one of the nurses came, called me in and said, “Well, I’m going to be your nurse for this session,” or whatever. 

So you’ve got like a checklist of things that you have, blood pressure and then something else and tick these things off as you go through.” And a blood test and I think I did have an x-ray that day? But I remember it being sort of very structured and on time and it, one thing rolled on to the next quite quickly. I wasn’t sat around for hours.

I think they warned me it would take like, you know, I don’t know, four hours or so I think it was and it did, just about. But I wasn’t sat around for ages I don’t think. So that was the lead, I think she must have been my lead nurse but I saw others for other bits of it. I think somebody else might have given me blood tests. Somebody else some other tests, you know. So and that was it. And then I went.

And did you see the doctor that day?

I think I did, yeah. I did, it was a different doctor because I think he was looking at the results of the blood pressure and things like that. I asked him a few questions, yeah.

Do you remember being shown the 3D videos?

Yeah.

How did you find them?

Good. Yeah, that’s the one, what I can’t remember what they were now, one was about the op itself wasn’t it, showed you the procedure or bits of it. Yeah, I thought it was quite informative. I didn’t find it sort of off putting or anything. No, I thought it was, I thought it was good.

Alan was ‘really impressed’ with the care from professionals and with the hospital. It was ‘brilliant’ to be in hospital for just the day. He had no problems at all.

It was, it was great. It was really good. I was really impressed because you hear this stuff don’t you about hospitals. But I mean the whole experience of the Nuffield [NHS hospital] was great. And my mother-in-law had two knees done there in the last couple of years and she, her experience has been just the same. Been really good because she had the knee and then I had the shoulder, and her second knee was booked in at the same time as it worked out. 

And she said, “Oh, don’t worry. It’ll be absolutely fine.” And we were both in there at the same time.

Oh really.

And yeah, she said, “It’s great.” And it was. So and luckily I was only in for a day. 

Yeah, that’s really good.

Which is brilliant, you know, as a day patient. When I first heard about it, I did think, ‘Oh like a day?’ But, yeah it was absolutely no problem at all.

The physio strapped Alan’s shoulder to improve his posture. It helped but he thinks that it may have starting leaning forwards again. Everything else was fine.

Have you had your post-op assessment, your follow up appointment?

I did, yeah. That must have been the one that I had most recently then when I saw the physiotherapist. Yeah, I think it was. That was the lady that was in the TEPI [videos]. Yeah, so I have had that, yeah.

And what happened at that appointment?

She looked at all the movements and asked how things were going and, you know, looked, we tried touching the ceiling sort of things. And she did spot that I’ve got this bad shoulder blade posture or something. So instead of like keeping your shoulder back and reaching for something, I’ve got a bad habit of like pushing my shoulder forward, which is not very good apparently. 

So she strapped me up to try and get it pulled back, which was, actually helped. It’s a bit uncomfortable with a big strip of plaster but it came off after about a week. So I’ve probably gone back to it. I’ve sort of consciously tried to keep it back but, in reality, I expect I’ve gone back to how it was before. 

Yeah. And was she happy with everything else? Everything else was okay?

Yeah, yeah.