Well, it has a big, long name. It’s called arthroscopic subacromial decompression or ASD for short. But that’s basically keyhole surgery of the shoulder, usually performed through two keyholes, one for the little camera, one for the little instruments.

And what the surgeon, and what were really trying to do at that point is to shave a spur or little prominence of bone from the roof of the shoulder, which has been catching on some tendons in your shoulder and causing the pain that you get when you lift your arm up.

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 well 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.

So an important part of surgery is having no pain afterwards. And traditionally people would wake up perhaps in pain, given painkillers and so forth. Now the anaesthetic teams that work with the surgeons are very motivated to ensure the patients are as comfortable as possible, so they use a nerve block. And that involves having some local anaesthetic put in at the side of the neck, which pretty much numbs the shoulder. But it can numb the entire arm.

So some patients do wake up and, while they’re completely comfortable, they find it quite an alien or weird experience because their arm is dead and they literally can’t feel it. And I think certainly one or two patients when I talk to them, they even have to look down quickly to make sure their arm is still there. Because they just can’t feel it and it is a bit of a dead weight up to about 24 hours. But on balance most patients usually report back that they’d rather have a pain-free, comfortable shoulder, even though it might feel like a bit of a dead weight of an arm for a while.

Well it was really helpful and they gave me all sorts of information about what will happen when I go in. And the main thing I was thinking when there, I will, I will feel the pain afterwards. How much pain I will get after the operation and they told me that with the, with the painkiller that they were giving me, I won’t feel anything and which is, which was true, which happened afterwards that I didn’t feel that because everything was numb at the time. But I had to keep this sling for twenty four hours.

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 weird sensation for me was obviously having the arm completely blocked with the nerve block, how did I cope with that? Oh that was a bit, bit stressful the first night. Obviously trying to carry a complete dead limb around and very conscious not to sort of like turn around and smack it against a door or wall. So I was really sort of like conscious of that.
Got back into the bed obviously after I’d been to the toilet, and I thought to myself, God I hope this comes off. And by about twenty past eleven the next day I could start feeling some I could rotate my arm, cos I couldn’t before, I was going slightly like this. And I could feel like a tingling sort of, like a pins and needles, and I knew that was going to happen because the information on my sheet which I read from [name] or [nurses name], the staff nurse downstairs, she made me read about all that and yeah it was, it was fine.

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, theres no heart or chest problems, theres 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.

I went in to a room and he [surgeon] was in there and he introduced himself. He was really nice, made me feel comfortable. Then he explained what was going on with my shoulder because I never knew what was going on, yeah. And basically what had happened is my bone had gone over in to like a little hook and it was putting pressure on my should-, on something inside there and what they needed to do was to get, remove this which then would relieve the pressure, which then would, yeah, right, which when I saw how it was, he actually showed me everything.

It was good because I understood what was going on with my body [laughs] because I didn’t know until then what was going on and it was actually nice that somebody was actually talking to me, listening to me, showing me and, you know, I actually, it was nice. Yeah.

He explained things well?

Everything, it was brilliant, yeah. He sat down and explained to me like I was a person and it was my body and I needed to know how I felt and yeah, it was lovely. And I can honestly say I came out of that room, Yes [laughs] like when I had that injection [laughs].

So it was relief too, to have someone who knew-

Who knew what was going on and showed me what was going on because, as I said, nobody had really explained to me what was going on. They said it was like, I had compression on this, and big words that I didn’t understand and even when I’d go to physio, the physios didn’t even know what was really going on. All they wanted to do was give me some light exercise which would then heal it but they were healing something that had grown which was not going to be healed, so, you know it was a complete waste of a year which could have been done differently, I think. The pain, everything could have been done differently.
But my pre-op made me forget about all my trouble that I’d had before [laughs]. The nurses were brilliant, they talked me through what would happen, how it would happen, you know yeah, it was brilliant.

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.

I watched it [TEPI videos] very quickly, briefly there and when I came home from that appointment I watched it again because I thought you know, when you’re sort of like, you’re sort of in a different environment, you don’t settle and watch it and take it all in the first time so it was really, and that’s what I found really good about it that you could look at it again.

So I looked at it again at home, the study, the pictures, the 3D pictures and got it in my head what was going to happen next at the pre-op and then the surgery itself and then afterwards which was very, very helpful. But, and the, just before I went to pre-op I looked at it again to make sure I had it in my mind what was going to happen there. Which was great, it was great to be able to dip into it when you needed it, when you’d forgotten something and that’s what I found was brilliant. And then after surgery too although I’d got it in my head more by that point I still looked again after surgery to help me with the exercises and make sure I was doing them correctly.

Okay so you dipped in and out?

Yes.

According to what you needed at that time.

At that time yes and what, every time I did it I watched, I looked at all of it but I took from it what I needed at that point. And then I went back later and did it again because I needed something else from it, then so it was really good, very good for that.

Did it answer your questions or was there something missing in the information as presented on the 3D images?

No, I felt everything was there. I felt it was the most, I have to say when I went into surgery at that time, I’ve had a few surgeries in the past, and when I went into surgery at that time I felt more equipped for it. I knew what was going to happen. I didn’t have to ask questions, I knew it. Although the doctor still asked you did you want to know this and no because I’d been looking at this and its fine, I know what’s going to happen, I know.
And I did feel more calm and relaxed than I’ve ever felt in surgery, yes going into surgery as calm as you can be, you know what I mean, so it was very good, very good, very helpful. I personally found it very helpful.

Are you following the exercises that they gave you?

Yes, yes, yes and of course they say, Use it as much as possible. So that’s what Ive been doing.

Okay. But you haven’t used the 3D pictures and the video to look at the exercise?

No, I should, shouldn’t I. [laughs] No. No.

Okay, because

I’ve got booklets. I’ve been taking them from the booklet, which I think is the same as what you, from the film.

Do you feel equally comfortable to be using the booklet as to be using the information on the internet? Or which one do you prefer?

Well, it’s easier to use the booklet because where my computer is, I can’t really do the exercises, do you know what I mean? So it’s easier to do the exercises, do them up in the bedroom and stuff.

Ah okay, okay. So it’s just a question of where, the location of the computer more than anything else. Okay, do you have an iPad?

Yes, I do.

Okay. Would you, have you tried to look at?

No, I haven’t actually, no. But yeah, that’s a good idea. Yeah.

Okay, so you think more in terms of computer for this type of

Yes, I know but I have been having a bit of trouble with my iPad on the internet so I suppose that’s why I’ve been doing it by the book really.

Okay, but do you feel, would you feel equally sort of comfortable using the booklet or the

Either really.

What do you think is the best way to be, to give this kind of information for people who are going to have surgery? Is it leaflet or is it on line, or is it both?

Both I would say because you know, like an older person, you know, like my mother for example, she wouldn’t have a computer. So, yeah, you need both really because older people they don’t go to the computer do they? So…

Okay, so it needs to be kept in both formats.

Yes, definitely, definitely.

My generation, younger people are more computer minded, my generation okay we are but were not, I personally am not so hooked on a computer as the younger generations, so therefore it makes, I think that makes a difference. A young person would want everything on there but when weve been brought up without them you sort of….

Okay, younger people just sort of look at websites for information now. So saying that, in that sense it’s not, do you have any thoughts about improving it or?

No, I think it was good.

Okay. Any particular thing that you didn’t like or?

No it was no problems at all, no I think the whole thing was good.

Okay, did you think that they gave you enough information?

Oh yeah.

Okay, okay. What do you think is the best way to give information to patients having this kind of surgery?

Well I think you’ll find this type of surgery, I mean I don’t know what the numbers are but I would imagine this sort of surgery is more in my age group and older. And therefore people are older than me, I still think they would prefer a book to the internet because it’s just the way they’ve always been.

Yes, did you look for, ever for more information elsewhere?

Yes, I went onto the net and watched a video of the operation.

Ah okay. So which site, do you remember the site you went to?

I might have got it in here, oh it’s a website I got onto. Oh MedlinePlus. MedlinePlus.

Did anyone suggest it for you to look at that website?

No, no, no, I’ve done it for other operations.

Okay, okay. It’s MedlinePlus yes, okay would you recommend, would you recommend it to others?

Yes, well it depends on their makeup, to me, my mother was a nurse and I’ve always sort of got a bit of nursing blood in me, therefore watching an operation doesn’t worry me. But if some people, some other people could, it could upset them to watch it.

Yes okay, so not you, okay. Okay. What mattered, what was most important to you in terms of having the information?

Well I think it makes you more relaxed, you know what’s going to happen.

Did you see that information again at home?

I didn’t but [my husband] looked through it and he spoke to me about certain things but I forget now to be honest.

So why, would you have preferred leaflets or booklets rather than information on the website?

I think really yes, it would have been easier for me to have a leaflet.

Why?

Because I’m not terribly good with the computers and that [laughs]. Sort of getting it up on the computer would be no good. [My husband] would have to do all that and… Quick, you know, I had a quick sort of, I must have had a quick read through it because he had it up on the computer you know, but my, but it’s, it doesn’t stay there very long, you know because my memory’s not too good at holding things. Memory, sort of remembering things, you know.

Okay, so you would have preferred it in a printed format?

Yeah, probably I would have looked at it more then, than just on the computer you know, which is

Okay. What did you think about the information that was, that you read on, on the site?

On the site? Well very interesting, you know and all the different exercises. I was amazed with some of the exercises to do, you know. I didn’t think there would be so many sort of exercises to do with the arm, you know.

I’ve never been quite so relaxed actually. It was very, very good, yes, because I’m not a big needle fan and that’s the bit that scares me the most, the needles and things.
And I just, I’ve got to say, because I think whether it was because I was armed with more information, I knew exactly what they were going to do. I don’t like gory details myself but there wasn’t any. It’s done in a way that it’s more practical information rather than gory information, if you had real people on there with open wounds I wouldn’t like it so much, so that for me is good.

So you like the 3D pictures?

Yes, I do, I prefer that than I couldn’t, I wouldn’t like it if it was sort of actually a shoulder being operated on, it doesn’t appeal to me as much.

But seeing the information made you relax?

Yes, I think so. I felt, because I felt I knew exactly what was coming and I just knew, knew exactly what was coming. I know doctors in the past have said that, you know, they tell you what’s happening, it doesn’t quite, it’s not quite the same as seeing little pictures about it and I felt that helped a lot. Something helped me because I didn’t feel quite so nervous.

So you saw it the day before surgery or?

No, on the day, oh I looked at that, yes I looked at it again, yes before I went into.

Into surgery.

Into the pre-op sorry, into the actual day surgery, I looked at it the day before just to get it to refresh my mind again.

Okay so the next day you felt well prepared?

Yes, absolutely well prepared, went in absolutely fine so yes, no problem at all.

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

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. Theres quite a few of them, theres 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.

Do you think you got enough information from them, from the doctor? From the nurse?

Oh yes, as far as the operation goes, yes. Everything was covered, yes.

Okay, so

But since I’ve had it, you know, as I say I’ve had no contact with a doctor to tell me or not whether they’re going to be doing the left one. They injected it while they was doing the operation on that one to take the pain away for as long as possible, but I don’t know if they’re now going to do it or whether they’re waiting to [sigh]….

Okay. So you just have to wait for an appointment?

Yeah.

To see a, okay. It just occurred to me when you went to see the physiotherapist, you were expecting to see the surgeon. Did you receive a letter saying that you are going to see a surgeon?

No, I just had a letter saying that I would be seeing [the physiotherapist] and I didn’t know what she was or who she was until I got there. You know, I just thought she was another one of the team of surgeons. But no, she was a leading physiotherapist or clinical practitioner, physio or someone. Shes high up whatever it is, you know. And it’s her I’ve got to go back and see, not the surgeon. So I don’t know where I stand as far as the second shoulder goes.

Did you ask, Am I seeing the surgeon today? or no?

Well I did tell her I was surprised I was not seeing him. I said I thought I would be seeing him and she said, No, you come to me, when you come post-op.

For post-op, you go to her?

Yeah.

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.