Mary

Age at interview: 45

Brief Outline: Mary injured her shoulder after a fall. She had physiotherapy, osteopathy, and three steroid injections before having subacromial surgery. The operation went well and the physiotherapist was pleased with her strength and range of movement. However, Mary continues to have achy pain that worsens when she exercise more actively.

Background: Mary is married and has three children. She works part-time as a beauty consultant. Ethnic background: White British.

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Mary started having shoulder problems after a bad fall in the garden. Although in pain, the next morning she was able to drive her kids to school and then herself to the hospital for an X-ray. It wasn’t broken and she started private physiotherapy to help her recover. After a while the physiotherapist recommended an MRI scan before she could move onto more active exercises. 

Mary had the scan done privately and then continued seeing the physiotherapist and an osteopath. Although her shoulder improved, she said that it kept catching and that she kept having pain in her upper arm. Any movement that involved lifting her elbow or anything across her body made it worse. She found it difficult to do certain domestic chores, including preparing vegetables and getting dressed. Mary also started having very painful episodes which were triggered by certain movements. The pain would settle down after she had it strapped, but it kept recurring. Eventually, she went to see the GP who referred her to hospital.

In hospital Mary was given a steroid injection and physiotherapy. The first injection gave short-term pain relief and the second – which was injected in two different places – gave pain relief for several months. She stepped up the exercise routine but, again, started getting severe pain in her shoulder. She had a third injection that helped a bit but didn’t take away the pain she felt from cross body movement. 

Mary opted to have subacromial decompression surgery after the injections failed to ease the pain for any length of time. The consultant talked to her in detail about all aspects of surgery and recovery. The consultant also showed her the Technology Enhanced Patient Information (TEPI) website. She had an operation the previous year, so was familiar with hospital routines but said that the TEPI videos were very useful in providing information about what would happen during surgery – she wasn’t shown videos before her previous operation. The TEPI videos also helped her family understand what the surgery involved and it reassured them. 

Mary said the pre-op assessment was ‘fantastic’ and that everything went smoothly on the day of surgery. At home, she continued recovering well and remembers that she started to do gentle exercise the second day after surgery. She stopped taking painkillers on the fifth day. She used the sling at night because she found it comfortable. About a week after surgery, she was driving again. A month after the operation - as she returned to normal activities, the achy pain returned and worsened when she exercised more actively. 

At the six week follow-up appointment, the physiotherapist was pleased with Mary’s strength and range of movement. She discovered that she had been doing one of the exercises incorrectly and wished she could have seen the physiotherapist sooner. At that appointment, she had her operated shoulder strapped to help correct the positioning. She started exercising again and said she improved and felt much better. At the time of interview, she was having episodes of severe pain that left her feeling frustrated because they were so sudden.

The videos were user friendly, informative and helpful. Mary watched them on an ipad. It was helpful to check that she was doing the exercises correctly.

They [TEPI videos] were very user friendly. They were very easy to use and I thought the information in them was very well put, displayed. It was very user friendly and very informative and helpful. The pre-op one wasn’t for me because I’d had a major operation the year before. It was just a sort of recap, so I didn’t have to pay an awful lot of attention to the first one. But it was good just to run through it as a recap and then it was... I thought it was really good to actually have diagrams and things to show exactly what was going to happen in the operation. 

And then the aftercare one, certainly with the exercises, I’ve used many, many times because I’ve been able to have it up on the iPad in the kitchen. So I could just have that because in the early days it was good to have a reminder to more, you just get in a sort of routine and an order of which to do them. And then it just becomes automatic to do them. But periodically I found it quite helpful just to go back and re-cap and just sort of check that I was doing what I should have or I hadn’t forgotten one or, so. 

And were you given information any other way, like a leaflet?

I had a leaflet as well. So I had, the leaflet was upstairs and then I had the other one in the kitchen. So between the two it was good.

The discharge letter, leaflet and TEPI video gave different information about when to get stitches removed. Mary should have had them removed earlier.

One other thing that I just thought of, when you, on your discharge notes you get given a note that sort of says about having the stitches taken out. And I, of course I, this was done just before Easter. I needed to, I would be needing to have them taken out round the Easter weekend. And so I can remember checking the thing and one, the discharge letter said one thing. The NOC [Nuffield Orthopaedic Centre, an NHS hospital] leaflet said another and then the TEPI website said another. So I thought, ‘Well is it, I think one said seven days. Another said ten days and another said fourteen days.’ That may not be quite correct but it was something like that.

So I tried to ring the number that I’d been given to ring and, being Easter week, there was nobody about and so we went with the, what the GP had said. And then of course when I got in there at fourteen or whatever it was, because of the bank holiday, we’d left it until afterwards and sort of, they sort of said, ‘Well you really should have come [laughs], you should have come in earlier.” So that was just feedback really to try and put all the paperwork to say the same thing [laughs].

Mary was doing an exercise wrong even though she’d read the booklet and watched the videos. An appointment 3 or 4 weeks after surgery would have been better.

I went back for my follow up appointment with oh, what’s her name, [physiotherapist’s name] and that would have been at about six weeks. And I, you’re just going to a clinic, you don’t know who you’re going to see but that’s actually, I did actually see [physiotherapist’s name] herself. And she went through various exercises and was pleased at the strength of it and how it was moving. 

There was just, I was explaining to her how it was becoming more painful again. It was more an achy pain, it was more a sort of, I was getting frustrated in the few weeks where you’re not doing very much, it hadn’t hurt at all. But as soon as I started doing more activity, back to the sort of things that I would like to be able to do, it was becoming un, it was uncomfortable.

And so we ran through the exercises that I had been given and found that one of them was the one where you lie on your front. You’re lifting your arms behind you but I wasn’t doing that one as it should be done. So I found that slightly frustrating because I’d got both the written document things that I’d come out of the hospital with, also the TEPI website which gives you very clear instructions. But I just wish I’d been able to see the physio sooner. I wish the follow up had been at maybe four weeks, three or four weeks rather than at six, nearly seven weeks. Because I just feel in that time, if I’d got that exercise corrected earlier then it would have made a bit, a lot more, do you know what I mean? You just, if that’s the one area that really needs strengthening, then if I hadn’t been doing it properly, then it’s not going to have done what it should do. So that was a little bit frustrating.

Mary was very impressed with her care. She was in a room with one other woman. The anaesthetist and consultants came to see her soon afterwards.

How did you find the care?

Really, really good. Very impressed with, I was sort of taken in and shown a bed on a ward, in fact I say ward, it was a room, there were only two of us in there. So that was, and she was very, the lady I was in a room with, was very sweet. And she had somebody with her so they were chattering away. 

And very, very soon after, in came the first person to do whatever, I can’t actually remember the order of things but things started happening very quickly. I’d got my book with me, expecting to be sat there for an hour but, no, it all sort of really happened really quickly, blood pressure and things. Anaesthetist came round. Mr [consultant’s name] came round, Mr [second consultant] came round and signed all the forms and things. 

And they sort of said, “I was second on the list or something, and so it wouldn’t, you know, it wouldn’t be a very long wait.” And I think by the time I’d got changed and put my stockings on and things, it was pretty much heading on down.

Mary’s shoulder was strapped up to reposition it. Sometime later, though, it had dipped again.

What she did at the follow up was to put this quite major taping on, which pulled it sort of up and back. And she said, “That’s the position it needs to be in. So if you can keep that on for a few days then it’ll help the brain dictate that that’s where the shoulder needs to be.” ‘Okay, this is fine.’ 

So off I went and by about the time I’d walked out of the NOC [Nuffield Orthopaedic Centre, NHS hospital] building in to the sort of atrium area there, it really was quite painful. So I thought, ‘Oh gosh, I’m supposed to be driving home.’ 

So I went and got a drink and took some pain relief there. By the time I got, I then drove back. By the time I got back, it was really shouting at me to sort of say, you know, “What’s going on?” and you know, you just think, ‘How can I be in such a, you know, how can just sort of repositioning this be, sorry how can it have got in to be quite so far, not the wrong place but you know what I mean.

So sort of back on pain relief and doing my best to do these exercises and, having being shown that where to put my arm and shoulder in this position, well having been shown and felt what the correct place was to do this exercise, I just found it incredibly difficult to read, to be able to do it myself. Although I knew what I should be doing, I just found it very, very difficult to actually recreate the same I’d been shown on that day. So I just carried on sort of doing it as best I could. 

And after about a week, I can’t remember exactly, I took the strapping stuff off, the tape off, and carried on with the exercises and again, you know, improvement, got much better. Complete, really completely pain free until about ten days ago when again something, did something, don’t, still don’t know, it was getting up in the morning. So I mean it wasn’t, you know, it wasn’t doing anything majorly different to out of normal, and got this real sort of excruciating, excruciating pain in the shoulder again. And back to this sort of thing of, you know, shoulder dipped and things. 

Mary kept her shoulder dry by using cling film. It felt better soon after surgery, which has been a positive experience.

Are there any messages or advice that you would give them [other people]?

Oh washing is probably the most frustrating thing afterwards. So it’s not really a message to them but it just suddenly struck me as being, I found cling filming, so I would cling film from here all the way over the whole area because it’s, you know, it’s alright to not shower for a couple of days. You can sort of wash and things but after a while you actually want to get sort of under the shower and have a, and I kept putting it off because I was worried about it, ‘No I’m going to do it.’ And that seemed to work really well.

So, just cling filming the, just start using the, about a, another bit of your body you can sort of put a bag on it and tie it on but your shoulder is quite hard to do that. So I found the cling film really, really helped on that. Sorry, what was the question?

Just whether you had any messages or advice to other patients who are going for the surgery?

No, I find it really a very positive, the whole thing from the pre-op to the day, it, and I mean it felt better, it felt better straight away.