Bone surgery

Views and experiences of healthcare from people who had shoulder surgery

Most people we interviewed were very happy with the care they got from doctors, nurses and physiotherapists. The process of being referred to hospital by a GP was often the most difficult part, particularly if it felt slow, though people were usually pleased with the care they were given once they were in the hospital system. Some people were given injections and/or physiotherapy before they were referred to hospital for x-rays and other tests to see if they were eligible for surgery. This was sometimes a frustrating time because they were in pain and the treatments they were trying (painkillers, physiotherapy and/or cortisone injections) did not ease it.

Sue describes having a steroid injection. It only eased the pain for a few hours. X-rays showed a build-up of calcium which was causing the pain.

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Age at interview: 48

Sex: Female

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Basically they do it [cortisone injection] with a scan so they can see where they’re injecting it into. They give you some, a little bit of anaesthetic in there and then the steroid goes in. And they tell you it’s going to hurt, probably for two weeks it will, you’ll feel discomfort. It was a little bit, initially it’s quite painful after the anaesthetic will wear away and then it should settle down.

They say the maximum I think it was a couple of days, I think they said it would be pretty painful and actually that was right. After the anaesthetic wore off it was more painful than normal but not excessive pain. And then it settled down after that. But no difference, no change as far as I was concerned. Other people, that may help other people but it didn’t have any knock on, didn’t have the desired effect for me.

You say that they did it with a scan; can you explain a little bit more?

Yes, you know like an ultrasound scan that you see babies with? So a little bit of gel there and a little machine, a gadget to run across it to see if they could see, what they could see with that was the inflammation of the tendon I think or ligament. I can’t remember which, I’m getting a bit confused. They could see the inflammation in there, which was what was giving me the pain, so they could inject, because of the guided thing with the scan they could inject into the right place for me. So yep.

I had my next appointment come through for probably five weeks after that roughly. It might have been less than that but it’s just roughly. And that’s to see the consultant again to see if it had worked and how it was and everything like that.

And by me explaining, as I said, it worked initially for about three hours because of the anaesthetic, they, he felt then that he knew what exactly the problem was in there because on the x-ray it wasn’t very clear. You could see sort of like a shadowing, like a little bit of calcium build up in there but it wasn’t definite.

Nicola was prescribed various painkillers by her GP when her shoulder first started hurting but they did little to ease the pain. She then had physiotherapy and two cortisone injections. The first injection eased the pain for about 6 months but the second helped only for around 2 months. It was at this stage that surgery was discussed. She’d been in pain for over a year.

Nicola was at her ‘wits end’ with pain. She could hardly use her arm but still had to work and look after her four children.

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Age at interview: 46

Sex: Female

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I went to the doctors. Said to the doctors about it and they gave me some, they told me to take paracetamol. And I couldn’t take ibuprofen because I had a peptic ulcer because again paracetamol, it didn’t do no good.

So I went back to the doctors, phoned them I think it was about three days later and said, “The pain’s even worse.” Okay, I’m crying with this pain which is again, oh I can’t even explain it. It was so, it hurt so much, yeah. And I went back to the doctors and the doctor then gave me some, I think it was [Naproxen] and then gave me some codeine, okay. And I took that and the codeine made me sick, made me very dizzy and I explained that to them because I went back the next day, no two days later.

And then they gave me tramadol and it kind of worked for the evening I think. I think because it knocked me out [laughs]. So I think I went to sleep, yeah. I’m still trying to work, still trying to help with my family, okay but I am literally crying now all the time and I phoned up the, she, sorry in that process they’d written to the hospital for me to be seen and nothing was happening.

So, the next time I phoned up, March, April, so by the end of April I was at my wits end with this pain. I couldn’t do nothing with my arm, couldn’t do nothing and they contacted the hospital again and in the meantime they sent me to physio. In the doctor they have a physio in [place name] and that made it worse. And I tried to tell the physio, “What you are doing is not working.” So round about May 16th, I went back to my doctors and I’d had enough. They phoned through to the Nuffield [NHS hospital] I think it was and they said they’d see me straight away.

I went up there on 17th May and sat down and they scanned my arm and told, and then they see what is wrong, what is going on in my arm and they gave me an injection, a steroid injection.

Olive took painkillers and had injections. She went back and forth to the GP and hospital over several months. She recalled that being referred was a problem but, once referred, the care was good and everything about the surgery was explained to her:

Olive would have liked to have been referred sooner. When the injections wore off, she felt that the doctors couldn’t do anything to help her.

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Age at interview: 76

Sex: Female

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I would have liked them [doctors] to have sent me to the hospital sooner, to get, to see what was the problem, you know. I know they sent me to have an x-ray on the shoulder but that didn’t help at all and then it was, oh dear, long, long time afterwards, me going back and forth.

When I didn’t go back for a long time, I thought, ‘Oh well, I’m taking these tablets,’ you know all the time. I thought they couldn’t be bothered and [my husband] was angry. He said, “No, you’re going back up to see them. You can’t be like this, be in such pain”, he said, “It’s making you ill.”

So we went back up and saw them. So then after some time I had a letter from the Nuffield [NHS hospital] to say to go down to see them and that’s when I had the first injection there, you see. And then for months and months afterwards, once the injection wore off, it [pain] came back again, you know. I put up with it for a long time and went back up to see...

Long time, meaning weeks?

No, no, no. Months and months I thought, ‘Oh dear’ you know. And then we went back up and saw them again and went back down for the second time for an injection. That worked for a few months and then it stopped and the pain came back and I thought’ ‘Well, they’re not, they can’t do anything for me,’ you know. That’s what I thought, ‘I’ve got to suffer this pain. They can’t do anything for me, so it’s not working.’

And in the end, [my husband] said, “Well you’ve got to come up again and see [doctor’s name] again. Go and see what she’s got, see if she can refer you back again to the hospital.

A few people talked about telephone consultations they’d had before they were referred to hospital by their local doctor. These consultations aimed to assess whether a hospital appointment would be appropriate or other courses of action. Sue had a phone consultation set up but ended up having to chase it up when no one called her. Everything ‘went smoothly and very quickly’, though, once she started having hospital appointments.

Sue was disappointed when her phone consultation failed to take place twice. She felt that she wasn’t getting any further with finding help.

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Age at interview: 48

Sex: Female

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They said that the GP, no I think it was the Nuffield [NHS hospital] send you an appointment for the consultation. I think that was the right way round and then you just phone them, well you phone to arrange the consultation basically. I think the GP refers you to the Nuffield [NHS hospital]. The [NHS hospital] then sent me a form to do a phone consultation or to arrange an appointment.

When I phoned the Nuffield [NHS hospital] to arrange that, they said I need a phone consultation. They set you a time and a date for that to happen and that didn’t happen because they decided, they wrote back to the GP saying I needed an x-ray first. So the first time it was because the x-ray wasn’t there.

And then the second time was because, when they looked at the x-ray, they thought I probably needed to see somebody rather than have a phone consultation because it wouldn’t have been, it wouldn’t have given, it wouldn’t have done anything more than talking to the GP or anything so.

Okay and did you know who you were going to talk to on the phone?

No, we didn’t. I just knew that somebody would phone me on that day at the time but they didn’t obviously because it didn’t happen.

Okay yes.

Sorry is that confusing?

No, it is now clear because, so that kind of information that I think is important for people to have.

Yes, yeah.

So you took the initiative and you phoned them?

Phoned them straight.

Okay, were you anxious or concerned why they haven’t phoned, or disappointed?

I was disappointed in some ways because I thought I’m not going any further forward than this and it still wasn’t getting any better. And I think probably in hindsight, if they could do anything differently, that phone consultation, either if it wasn’t going to happen then perhaps they could have let me know it wasn't going to happen and why. And that way I wouldn’t have had to make my own appointment to go back to the GP. And then just start, and then I had to start the whole process again because they then had to re-refer me after the x-ray was sent in basically.

A doctor talks about the telephone consultations used to assess patients.

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So I think for many patients, they’ll be aware traditionally that a referral to the hospital really was about their GP writing a letter, sending it through to the hospital and then the patient would be seen in an Outpatient clinic. And generally speaking that’s changed throughout the UK at the moment. And there’s a sort of an intermediate service or triage service which has been put in place between GPs and the hospitals. And that service or that triage hub generally receive the letters from the GP and then look at those letters and make a decision about whether that letter is passed through to the hospital or not.

And although I think some patients get quite frustrated by that, because the feeling will be, “Well, the GP has made the referral. I should be seen”, what these intermediate services are doing is perhaps identifying that maybe some more physiotherapy or perhaps another injection into the shoulder might be the right type of treatment at that point for that patient.

So some referrals are passed through. Some are delayed. And then that often involves a telephone consultation as well, just to talk through those aspects about whether the referral is passed through. But it’s not something that the hospitals have put in place. But it’s something that’s pretty much in place throughout the country at the moment, sitting between General Practice and sitting between the hospitals.

So when a patient gets one of these calls, who will generally be making that call? Or can that vary?

It will vary. It may be a nurse, it may be a physiotherapist, it may be a doctor. But that would vary throughout the country. It is different in different regions at present. In our own area, it’s usually a physiotherapist.

So it would be a health professional?

It usually is, but I don’t think it necessarily is throughout the country.

Ken had to wait over 3 months to get a hospital appointment after being referred by his GP, which was ‘annoying’. Once he started having appointments, though, he had ‘no complaints whatsoever’ about the care he was given:

Waiting for a hospital appointment was ‘hard work’. Ken was in pain, felt grumpy, short tempered, and wary of going out in case anyone bumped into him.

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Age at interview: 46

Sex: Male

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The GP also tried to arrange the appointment with the Nuffield [NHS hospital] but I think they said there’s no space. You waited for three or four months which is just, just slightly annoying. I know the consultant or everybody is doing their best but it’s just that three months is really hard work.

Okay, so that would be your only comment.

That’s my only comment is that, that's all. Everything else, everybody I met is really working really hard so tried their best to help me, so I’ve got no complaint with the person whatsoever.

Okay, and do you feel that sort of your questions were answered, your concerns were sort of also answered?

Yes because, not concerns as such, because the consultant was very, yeah very detailed in everything. They tell me exactly what’s going on, what’s happening and what would happen before, after and everything else. So I had no concern. I had no concern whatsoever because I know exactly what had been done to me.

Okay, and when you had those, that sort of waiting time, waiting period, when you were in pain. How were you feeling in yourself because I mean pain really affects us?

It does, very grumpy, very short tempered. Also very unsocial because you, when you’re in pain you don’t like to go out. You’re very unsociable. You’re very short tempered and it just, it’s because the pain drives you, so it’s just like become, you don’t want to get to, you just don’t want to go out or, you know, any place just in case somebody knocks you on the shoulder and it hurts.

Pre-operative assessment

When participants knew they were eligible for surgery – having tried other treatments first and after x-rays had identified a problem – the next appointment was usually the pre-operative assessment. At this appointment routine medical tests are carried out, including blood tests, a urine test and an ECG to record the electrical activity of the heart.

A doctor explains what happens at the pre-operative assessment.

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I think that pre-operative assessment probably has a couple of roles. One is you get to meet the surgeon or the surgical team again to go through things in more detail in regard to the operation. Sometimes you don’t quite get all the information you need as a patient when you’re in a busy Outpatients. So the pre-assessment gives you an opportunity to speak to the surgical team again. Usually that’s when your consent form is signed. So you get to talk about the risks and the benefits of that operation.

But the other main role of the pre-admission is sort of a bit like having an MOT, where the nursing staff, the junior doctors will just make sure that you’re fit enough to have that operation, there’s no heart or chest problems, there’s no other illnesses that might have an impact. So it’s all about trying to make sure that, when you come in for your operation, things run as smoothly as possible.

And what sort of tests could patients expect to have at the pre-op assessment?

Well, they’ll usually have an examination of their heart and their lungs. They’ll have a tracing of their heart and they’ll have some routine blood tests done. Those are the standard things. It’s possible during those simple tests that the doctors may pick up something that requires further, more complicated tests. And occasionally that might slow down or delay your operation. But it’s all generally done with your best interests at heart.

Some patients mentioned filling out a questionnaire. Is there usually a questionnaire as well?

I think that will vary from hospital to hospital. There are something called Patient Reported Outcome Measures, or PROMs for short, these days. And it’s a big drive by the Health Service and the government to ask patients to complete scores about how painful or how much trouble they’re having, whether it’s their shoulder or their knee or their hip. And those can be repeated after the operation as well. And it’s really aimed at trying to identify how they’re improving, how quickly they improve and making sure that they’re getting a good benefit from their treating centre.

This video explains more about the pre-operative assessment.

Many people praised the information they were given and said that the pre-op assessment was well organised and well structured. Mary described it as a ‘roundabout’ of seeing different health professionals and that it was ‘fantastic’.

Sue describes what happens at the pre-op assessment. She had lots of tests and saw different professionals. It was well thought out and thorough.

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Age at interview: 48

Sex: Female

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You see a nurse and you have your bloods taken. You have your blood pressure taken, you have a little discussion with another nurse and then have an ECG just to make sure that I was fit for surgery before going, whereas on previous pre-ops I’ve literally just, you just do a few forms and bits and pieces. It wasn’t quite so in depth of all the bits they needed to know.

But it was very, very well thought out. You arrive and you sit there and somebody calls you and you have a tick sheet to where you’ve been. And you go in and you see one person and they do your blood pressure. And then you go to the next person who is ready for you, and you might wait a bit in between but I was out of their very quickly, I would say I was there for about an hour and a half. And they said allow five hours, so it was very quick.

Okay. So you had all these tests done?

Yes, and you see a consultant. You can see the consultant you saw before and also saw somebody to do with the anaesthetic side of things as well. And they talk to you a bit about, because you have a nerve blocking which that explains as well, the 3D thing [TEPI videos] explains as well. And that was very good, I’d recommend that.

So you have seen the pre-op information on the 3D video?

Yes, yes, and it ties in with what I was, what happened in that 3D.

Okay, did you have any questions; did you ask any questions at the pre-op?

I didn’t because I didn’t need to. I felt it was all answered for me with that and with what people told you as you went through.

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.

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Age at interview: 63

Sex: Male

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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.

Most people were happy with the tests and information given at the pre-op assessment. There was usually little waiting around as participants had one test after another. Margaret, though, ended up waiting and felt disappointed, describing the appointment as ‘horrendous’:

Margaret couldn’t understand the nurse who went through a long form with her. He seemed to be ‘going through the motions’. There was a lot of hanging around.

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Age at interview: 71

Sex: Female

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We got there [hospital] for half past eleven I think it was and we left at half past three. It was horrendous. We waited so long and then we were assigned to a nurse. I don’t know if he was Spanish or what he was. But my husband couldn’t understand him and it was a job to understand him.

And we had to fill in an eighteen page questionnaire and, when we went in to a room with a nurse, he went through all these questions again. And I just thought that was a waste of time, you know. Why fill in all these questions and then why, and then he could have used all the information on there. But I found that he was just, what’s the word? Not concentrating on what he was saying. He was just going through the motions and he asked me, “Had we any children?” And I said “No.” “Have you any grandchildren?”

Argh.

So I said, as I haven’t got any children, I haven’t got any grandchildren. And I thought that was poor that he was just going through the motions with the form. And it was just the amount of time for hanging around going through the different things.

What were the kind of things that you had to do that day?

Had to have ECG, blood test.

In hospital

Most people we spoke to were pleased with the care they’d been given in hospital by health professionals, including nurses, physios, consultants and anaesthetists. Jasmine said they were supportive and caring, Beverley that she had ‘good care’, and Olive that she recovered so well that she had no need to see the professionals again. Beverley, like a few other people, noted that the timing of tests and surgery went well and there were no delays.

Manuel’s care was ‘near perfect’. The doctors and nurses were very good and he felt well looked after.

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Age at interview: 44

Sex: Male

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How do you feel about the healthcare that has been provided or you have received? I mean healthcare in general, how....

Well it’s near, near perfect, you know. I mean where can you receive healthcare like this, you know. You, from day one to last minute of what [condition] you’re complaining for, it’s being looked after.

And they still like, they’ve got follow up, follow up on what they do to you. And like if you go in private hospital basically, I mean if you don’t have the money [laughs], you can’t go back now unless you have the money to pay the doctors for a visit [laughs]. And it’s just asking some simple questions basically. I mean, from the doctors to the nurses, to all the people that’s involved in doing the healthcare, it’s good. Very, very good.

One woman said she had ‘excellent care’ that she ‘couldn’t fault’. All the professionals were good and she was particularly ‘impressed’ with the surgeon and registrar who explained everything she needed to know about the operation. The ward care was also good and the hospital was clean. David felt that his healthcare had been ‘excellent’ and the hospital was ‘spotless’. He said he’d been ‘very impressed’ despite the negative publicity the National Health Service often gets. Mary commented that both doctors she saw on the day of the operation were professional and friendly, and that one of them was light-hearted which was ‘what you want on the morning. You’re a little bit anxious or whatever about what’s going to happen during the day. So being very smiley and friendly was really just what was needed.’ For Wayne, the care was ‘gold star all the way....10 out of 10’.

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.

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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.

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Age at interview: 45

Sex: Female

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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.

Alan praised the staff he saw at the pre-op assessment and later in hospital. He’d never had an operation before but was reassured by his mother-in-law that he had nothing to worry about – she went in for a knee operation on the same day:

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.

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Age at interview: 63

Sex: Male

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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.

Nicola said the staff were all good and treated her as an equal. She felt ‘like an actual person and not just a number’:

The whole experience was brilliant. The nurses and doctors were good. Nicola felt they listened to her and explained everything in words she could understand.

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Age at interview: 46

Sex: Female

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The nurses and the consultants they were really nice. They understood what was going on. They made you feel, I didn’t feel below them or anything. I felt like an equal with them. You know, they were very friendly and watching a video and it explained everything to me in normal terms because I’m just a normal, average mum, you know.

And sometimes doctors use words or they sit there and they just write things, you know. They never give you no eye contact. They never listen to you really and then you kind of clam up and you don’t really tell them exactly what is really going on. But that was completely different. The whole experience, from going to the consultant to coming out after the operation, was brilliant.

Okay, so the language they used is language that we use, non-doctor, non-medical people?

Yes, he was lovely. And even the letter that he sent to my doctor, and I got a copy of it, it was, “Today I met this lovely young lady, you know, and she’s going to be da, da, da.” And it was, it put a smile on my face, you know, that he called me, “a nice young lady”. And he talked to me and explained things and the whole letter, it was nice. It was like I was an actual person and not just a number or something. So it was nice, yeah.

Rosemary was disappointed with a nurse who she felt discharged her even though she was feeling dizzy and lightheaded. Patients are not usually discharged if they are unsteady or unwell and so, if they are concerned, they should inform the nursing staff that they would like to see the surgical team or anaesthetist again. One woman felt that a nurse had been ‘dismissive’ when her husband asked how long the operation would be as he’d be waiting for her during this time. Other than that, though, she was ‘very, very impressed’ with the care and ‘can’t fault it at all’.

Rosemary would have liked to stay in hospital overnight but felt the nurse wanted her to go home. She was feeling dizzy and didn’t feel safe to go back home.

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Age at interview: 62

Sex: Female

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I’m not a nurse, I’m not a doctor, but if somebody’s dizzy and lightheaded, and obviously I was bleeding quite a lot internally because I had such extensive bruising, and actually that’s another, because she had to change the dressing because it was, the dressing on the shoulder was, I was bleeding quite badly out of the wound. So she did have to put extra, well she just, she didn’t, she just put extra dressings on top. Which didn’t, I even wondered if the steri strip or something had come off. But she just put extra dressings on top because it was, well it was just wet and I was bleeding. The dressing they’d put on in the theatre was wet.

Did you see the doctor that, afterwards, after the operation?

Yes, yes, he said to me ‘look if you don’t feel right, you should stay overnight’ but, then obviously the nurses have the last say don’t they. I mean if I’d pushed, you know, I could have stayed, but she was more keen for me to go. And when somebody, if somebody’s wanting you to go, it’s a horrible feeling, you know. So you think, well just go. You’re sensitive aren’t you.

How did you feel about that, what did you think about her attitude?

Well I thought it was wrong, but I would have thought if somebody can’t walk very far, are they safe to go home, but there we are.

Patricia had a very difficult time after surgery and was disappointed with it and the amount of time it was taking to get a physiotherapy appointment. She still had a lot of pain and limited arm movement:

Patricia’s arm and shoulder are still very stiff. She feels that surgery hasn’t helped. She is waiting to have physio and to see the consultant in 3 months’ time.

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Patricia’s arm and shoulder are still very stiff. She feels that surgery hasn’t helped. She is waiting to have physio and to see the consultant in 3 months’ time.

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Age at interview: 69

Sex: Female

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Patricia: I can’t do my hair properly.

Husband: She can’t do that.

So you can’t put your arm and then....

Patricia: No. No, I can’t put it any further than that and that hurts here, up here.

So just by putting your hand on your shoulder?

Patricia: Yeah, so I can’t do my hair with that. I mean I have to do it with this hand and, you know, I just can’t get any further than that.

Okay, so in practical terms you don’t

Patricia: I don’t feel I’ve had any benefit at all from the operation.

Husband: And you can’t be denied those feelings. No matter what people say, that’s how you feel isn’t it.

Patricia: I mean I would, my car is sitting outside. It’s been out there for all this time. I would love to be able to drive it. I’ve driven it just once....But I wouldn’t want to do it on my own because if I had an accident and it’s not always your fault is it? It could be somebody else, then I’d be in trouble no doubt for driving when I shouldn’t be.

Yeah, you have very limited movement here in your shoulder. So it has had implications for your everyday life.

Patricia: Yeah, it has. Certainly...

Husband: All we can hope is that we keep on locally about regular physiotherapy appointments and that they spend some time with my wife trying to get the movement a bit more or at least stop it stiffening anymore. And then by that time, when and if we’re offered this three month appointment, and my wife’s examined again by the consultant at Nuffield [NHS hospital], some improvement will have been made. But there’s no guarantee of that the way she feels at the moment.

And what would you like to happen? Would you like to have another operation?

Patricia: If I thought there was any hope of it improving, yes I would go through that again. But I was very optimistic the first time and that wasn’t just brought about by me. It was brought about by what I understood the consultants to say that they could make some improvement. Nothing’s improved. Nothing...

Husband: It’s being suggested that it’s still early days after the operation, the physio will... And so therefore, effectively we’re on hold again while the physio has some, hopefully has some effect and the consultant at Nuffield [NHS hospital] sees my wife again in three months’ time.

Recovery

Participants went home the same day as having surgery and had no need to contact the hospital again, only going back for a routine follow-up appointment. A telephone number was often provided in case there were problems. Some people would have liked more information on managing at home in the early stages of recovery, while others would have liked a physiotherapy appointment sooner after surgery so they could find out if they could progress to more challenging exercises. Most people were pleased to have been given a booklet of exercises and the TEPI website address so they could keep checking that they were doing the exercises correctly.

Manuel did his exercises watching the TEPI video. He felt he was having physiotherapy at home. The exercises kept him busy all day while he was recovering.

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Age at interview: 44

Sex: Male

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When you started your exercises, your post-op exercises, you were looking at the website or you were checking the leaflet?

I was looking at the website. I was doing it at the same time while I’m watching it. So it guided me properly because obviously if you just read it, you just see it on the images, just right hand raise, you know, what they’re doing. But if I’m looking at the actual video, it actually says what’s the limit of what I can do and which point I have to do it, you know, like raising your hands and to what extent. So it, the video is actually good.

So you have seen the pre-op exercises, the post-op exercises more than once?

Yeah, I use it every day when I was doing the, so I have to go there.

Ah, okay.

Watch it and follow each exercises. It helps, it’s just like having an exercise with somebody as well. It’s just like two of you doing it at the same time. It’s just like having physiotherapy by your side basically. So it is good.

Okay. So this is a kind of visual, virtual physiotherapy session?

Yes, exactly.

Okay, no that’s very interesting.

So, and how does it make you feel? I mean more confident to do the exercises? How does it make you feel to have this kind of visual session?

Well the instructions is there, so it’s easier to follow. The only thing is until up to what time you have to do it, but again that information was provided already before, sorry after the operation. You can do the exercises in short frequent sessions. So I watch it, do one session, then stop for half an hour, do the next one. Then stop again for half an hour. So that kept me busy for the whole day basically being at home, alone at home [laughs].

The follow-up appointment

Many people talked about the follow-up appointment, which was often 6 weeks after surgery, and what happened at it (see ‘The follow-up appointment for shoulder surgery’).

A doctor explains what happens at follow-up and who to contact if there are shoulder problems after that.

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This [follow-up] will vary throughout the country. Certainly in our own region, our own centre, most patients after this type of shoulder operation will come back to Outpatients at 6 weeks. And at 6 weeks they’ll either see one of the surgical team or perhaps more importantly they’ll see the physiotherapist. Because after surgery, it’s usually down to the rehabilitation and the physiotherapy. So they may not see their surgeon again. If they see the physio and they’re doing well and they’re happy with their exercises, they may not see the surgeon. If they’re not doing as well, the surgeon is usually called in to say hello and to have a look at them as well.

And generally speaking most patients aren’t discharged from hospital care until they’ve got the result that they want. So it’s not usually an issue of struggling to get back in contact. That line of contact should be open until they’re better. But otherwise obviously their GP is a great source of information and can usually get back in contact with the hospital team if needed.

And when they attend the follow-up appointment, what happens at the appointment? Some people wondered if they’d have x-rays. What usually happens?

So after this particular type of operation, where a little bit of bone has been trimmed from the shoulder, nothing has been put in, so x-rays aren’t usually required. It’s all about ensuring that the pain is improving, the range of movement is improving. So it’s really about physiotherapy and exercises. And that’s what is looked at and that’s what is checked. And the physios may then modify or change the rehabilitation or the exercises that need to be done by that patient.

Many patients ask about physiotherapy after this operation. And actually again that will vary throughout the country. Many patients won’t see a physiotherapist during those first 6 weeks. And that’s because most people after this operation can just get on with their own exercises, their own rehabilitation. And they get checked at the 6-week mark with the physiotherapist. Those that are doing well can probably just carry on as they are. Those that are struggling a little are usually picked up by the physios at that point and may need some more concerted input.

So patients can do gentle exercise, or if they feel able to move on to something a bit more challenging, that’s okay?

Again I think the important thing to remember after this operation is you can pretty much let your shoulder tell you. If your shoulder is feeling comfortable, you can increase the level of activity and do more and more things without worrying about harming your shoulder. If it gets sore, it probably means you did a bit too much and you just need to cut down things a little, and then try again a week or two later.

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Last reviewed August 2018.