Age at interview: 46
Brief Outline: Ken had a sharp pain in his shoulder that often woke him up at night and limited his ability to carry out everyday tasks such as holding a shopping bag. He went to see his GP who initially suggested physiotherapy, however when this didn’t work he was referred to a specialist. He received a steroid injection to help with his pain, but pain relief was short-lived and eventually he was told he needed surgery. Ken’s surgery went well and he is now able to do everyday tasks he wasn’t able to do before surgery.
Background: Ken is married and has one child. Works as a full-time buyer. Ethnic background: Chinese.

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At first, Ken didn’t realise there was a problem with his shoulder because he thought the pain may have been due to playing a lot of badminton. His shoulder pain started to affect work and every-day life but it wasn’t until the pain started to wake him up at night that Ken decided to make an appointment to see the GP. 

His GP sent him to have physiotherapy, but it didn’t help, so Ken was referred to a specialist, who explained what was wrong with his shoulder. Ken found out he had a shoulder impingement and was given a cortisone injection to relieve the pain. The effect of the injection lasted only two weeks and after that he was told that surgery was his best option.

Ken was told that he had to wait three to four months for surgery – he found the waiting difficult. While waiting for surgery he said he was short tempered and somewhat antisocial and reclusive. He was afraid that someone might bump into his shoulder and cause him a lot of pain, so he often preferred to stay at home, which affected his quality of life. 

During his pre-op, Ken said he had everything explained to him in detail and all of his concerns were addressed. He was told exactly what would happen during his surgery. He was also given a leaflet and a video to watch, and although he felt the leaflet was not detailed enough, he liked the video. 

Ken feels that his operation went well and he is happy with the results because he has no problems with his shoulder. His only grievance is that he wasn’t made aware of the possible side effects of the painkillers he was given to take home after surgery. They made him feel very nauseous and drowsy. 

During his recovery, his wife took care of him for the first two days, as he needed help with showering. However, after about ten days, Ken was able to drive his car and go back to work and feels he can now do normal things he wasn’t able to do before surgery.

Ken thinks the overall healthcare he received was excellent, but said that the post-op exercises were too easy for someone like him. He said that post-op exercises should be tailored to the level of fitness and the age of the patient. During the post-op recovery period, he used his own weights at home to strengthen his arm.

The surgeon ‘did a really good job’ explaining why Ken needed surgery. He’d played a lot of badminton before and had developed a bone overgrowth

The first time they said it was shoulder impingement I believe as in the term was shoulder impingement, and then they did the injection and what the consultant said was, if it goes away it’s great, if it comes back, it come back and we do, we see again. 
And when it came back a second time round they do the, I think they do the x-ray and they did find that this bit of let’s say bone sticking out that need to be cut so yes. Yes, so at the consultant they did a really good job from beginning to end, so I’ve got no problem with that.

Okay. So when you had your pre-op they?

Yes, they explained everything and what needed to be done and everything, yes that’s fine.

Okay, so did you have any questions or any concerns at that point?

I had one or two points asking, but I think that it was all addressed with properly so it’s not our problem at all. It’s like because I was like oh what’s going on and why is it, why is it growing or why is it there in the first place, and it was explained to me quite well so I don’t have any problem at all with that.

Do you remember what he or she said?

Yes, what the consultant said was something to do with, because I did a lot of exercise and I think the muscle brushed against the blade, the shoulder blade, and I think something to do with the bone in defence want to grow the bit just to protect itself but it made it worse for, it’s better for the bone, the bone itself but it made it worse for the body where it touched and nerves or whatever, that’s fine, it was my own body trying to protect my, to protect itself, that’s all it is.

Okay so it was caused by?

It was caused by a lot of let’s say, I think it was probably a lot of exercise or a lot of badminton I expect.

The TEPI exercises were for older, ‘non-sporty’ people. Ken used YouTube and other websites to find more so he could improve quickly and play sports again.

I did all my exercises, yes I did, I did bit by bit, I did bit by bit.

Okay, so were you using the online information for that?

I think that, yes I did use it on, I have, I’ve got the booklet, I look at the booklet and it’s, the exercise on the booklet is not severe enough for me because I want to get back to doing my sport a lot quicker. So I did, I went in there and I did take it a bit further just to get a bit more severe or stronger exercise to build up my muscle.

So which line, sorry which website did you use for that?

To be honest I don’t know because I just go on there, I type in SAD or you know, subacromial decompression, and also I go on Youtube. There’s quite a few of them, there’s quite a few of them explain on there what exercise you need to do just to, which muscle.

But did you use the online information the doctors, the consultant showed you?

I did yes, I did that one, it’s okay but it’s just too easy for me. It’s more, to me it feels like more for like a non-sporty type of person or like or for someone like older person. It’s okay but for a youngster, I think you need a little bit more than that because I just said I need to come back to sport because otherwise I’m putting on weight and everything else, and so I tried that bit harder. So yes, so it was a lot easier, so I try a lot harder and I thought the harder I try the more power, I feel that I’ve got more power in my arm.

Okay, so there is more strength?

Absolutely, yes.

Ken would like the TEPI exercises to be tailored for use by different age groups and fitness levels. He found them easy and had done them all by the first week.

All the exercise they asked me to do on the thing [TEPI videos and booklet], I probably done it all in less than a week and I’d done everything, that’s more than they ask for already. 

And I could do a lot more and I would recover a lot quicker than majority, as I say, of the older people. So that’s what I say, I think there should be some terminology where you can ask people and say, you know, or some kind of table of some kind, that’s you know, or a graph for example, this is the age, you know, or whatever you come, which group category you come under and you might be able to do that. You don’t have to but it says you might be able to. 

I would like to see if it says something like, for example, okay if you’re 18-25 and very fit you probably can do something like 40, 30 or 40 seconds rather than 10 seconds, it depends on how you, or something like it depends on your age right, you know, or how fit you are. 

You can do from ten seconds if you are able to or 50 seconds or a minute if you are really fit, and if you want to and are determined to get back or something like that. So at least let people know how, you know, because a lot of people just follow the doctor, you know, everything ten seconds that’s it. I do ten seconds, but if the doctor tells you like say which type that you might fit into or which category you might fit into.

Okay, no that’s very good, that’s very good information. So I mean just to give the same information but to cater for different groups?

Different groups, yeah.

Of the population.

That’s right, yes.

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.

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. 

Before surgery Ken found it painful to drive, play sports, vacuum, wash up and use his computer. After surgery his shoulder is ‘brilliant’.

So it virtually stopped me [doing] a lot of things, everything from normal, to be frank I find it hard even to drive. Because if you drive you’re hand hold like this, no problem, when you turn left it’s no problem. When you turn right, this hand has to move up and turn, it’s really, really painful so I found it hard to drive and I virtually cannot ride my motorbike. And I can’t do any sport and I can’t do most things at home because, to be fair, I like very simple thing like washing up or hoover, I can’t do because of this, I think it's, like my thing has been locked because anything move, anything out something like 45 degree from that side is still really painful.

Okay, this was before surgery?

This was before surgery, yes.

And any effect on your work life I mean?

After surgery?

No, before surgery.

Yes, because right okay there’s two things like, because I’m a buyer and I use computer a lot okay, so my right hand is the main one that I use a lot on the mouse. So it’s one of those ones you see on your desk, you start using the mouse right, you limit yourself to a very small angle.

Sometimes even the mouse or you just like say slightly pull, you move your hand out of the limited angle and its really painful, so yes it does. So you virtually, I virtually, it’s like you just try to, it’s like I’m tying myself, my arm against my body like that so as long as I move like this it’s fine, anything outside that, its really painful.

Okay. And how does it compare to after the surgery?

After the surgery it's brilliant, it’s not too much, I mean my normal things. I even tried playing badminton last week it, everything is as good, back to normal apart from the niggling pain on the collar bone and that bit, everything is perfectly back to normal. 
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