Although the people we interviewed had often heard of keyhole surgery, most had never heard of subacromial shoulder decompression surgery (keyhole shoulder surgery), apart from Jenny, who used to be a nurse, and Rosemary, whose friends had had the operation.
People found out more about it from the surgeon when they were told they were eligible for it, sometimes after cortisone injections and/or physiotherapy had failed to ease the pain for any length of time.
Many people were happy with the information the consultant gave them about the causes of pain, what the operation involved, the risks and recovery. Some were given a choice between more cortisone injections or surgery. 1 or 2 cortisone injections are often given to help people’s pain and allow them to more easily do their physiotherapy exercises. Multiple injections are usually discouraged as they may weaken tendons over time.
A doctor explains what subacromial shoulder surgery is?
Alan was given a choice of cortisone injections or surgery. He was sceptical about having another injection and more physio, so opted for surgery.
The information the surgeon gave Jasmine covered everything she wanted to know about surgery. When she wondered if she’d be in pain afterwards, the consultant explained that a nerve block would be given before the operation to numb the shoulder and arm, and this would last up to 24 hours. Painkillers, such as codeine and ibuprofen, would be used after the nerve block had worn off.
This video explains more about shoulder surgery:
A doctor explains why a nerve block is given and how the shoulder and arm feel immediately after surgery.
Jasmine was worried about how much pain shed be in after surgery. Her arm was numb afterwards and in a sling.
Most people felt prepared for having a nerve block. Wayne’s only concern was that the injection was given in the right place but he said he “knew exactly what he was entering into” when he agreed to have surgery.
Alan had never had anaesthetic before, or an operation, and was anxious about “the unknown”:
The consultant explained the success rates and risks, including frozen shoulder. Alan chose to have surgery and his name was put on the cancellation list.
Having a numb, ‘dead’ arm immediately after surgery felt strange to several people even though they’d been told about the effects of the nerve block:
Having a dead’ arm was a weird sensation. Wayne was a bit worried the first night. Hed read the leaflet and knew he could get tingling later.
Information about the operation had often been given before and at 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.
This video explains more about the pre-operative assessment:
The surgeon gave Nicola a brilliant’ explanation about why shed been having shoulder pain. She came back from the pre-op assessment relieved.
Other health professionals at the hospital also gave helpful information, including nurses, physiotherapists and the anaesthetist. Many participants felt they had all the information they needed. The information that professionals gave Jasmine helped her “to keep calm” while Olive felt “relieved” because having appointments and leaflets meant she was finally getting help for her very painful shoulder.
At the pre-op assessment participants were also shown a new type of digital information that includes 3D pictures and videos, that can be watched and listened to on the internet. This is called technology-enhanced patient information (TEPI). The 3D animated videos are designed to help people understand why they need keyhole shoulder surgery, what it involves and the different stages involved, from pre-operative assessment to recovery.
Everyone we interviewed, apart from Patricia, had been shown the videos at this appointment. Rosemary said the surgery “couldn’t have been explained better”. The surgeon talked through everything first and then the TEPI videos explained it all again.
The surgeon did a really good job’ explaining why Ken needed surgery. Hed played a lot of badminton before and had developed a bone overgrowth
For some, the information given by doctors and on the TEPI videos was good and told them everything they’d wanted to know. For Jasmine, this meant that there were “no surprises” and everything happened as it had been described. Rosemary “went into hospital fully confident” and had “no qualms”.
Many people watched the TEPI videos at home too, especially the exercises that were recommended, often praising the videos for being clear, accessible, user-friendly, informative and easy to understand. Jenny said they “answer all my questions without getting complicated”, and Sue suggested that such videos should be available for other operations as well. Although she’s “not great with computers”, she watched the TEPI videos at home as well as in hospital because they were easy to access and “all one place”.
Sue found the videos brilliant. She dipped in and out and watched them whenever shed forgotten something. She felt calm, relaxed and equipped’ for surgery.
everley felt the TEPI videos were “a great help” but she didn’t look at them again because all her questions had been answered. She’d had shoulder surgery in the past and felt she knew what to expect. She found the exercise booklet easier to use than the computer and said her only query was whether she’d get calcium build up in her shoulder again.
Beverley likes having information in written and visual formats. Older people don’t always use a computer so having both formats is useful.
Olive, a 76-year-old, remembered seeing the TEPI exercise video but not the videos about the operation and risks. Her husband watched the videos at home but she didn’t, saying she preferred leaflets to websites and “wasn’t terribly good with computers”. Her son had also had keyhole shoulder surgery and advised her to exercise and avoid lifting anything heavy.
Rosemary was given a “very good” booklet of exercises and the TEPI website address but couldn’t access the site from home. She felt the website was similar to the booklet so didn’t mind seeing it only once at the hospital. She also felt more comfortable sitting in a chair reading a booklet than using a computer.
Rosemary isn’t computer minded’ and prefers booklets to the internet. She watched the operation online and felt relaxed knowing what was going to happen.
Olive felt that the video information was good but “you don’t take it all in, in that first visit”. Having the leaflets helped, particularly, as Olive noted, as some people don’t have a computer at home or know how to use one.
Olives memory isn’t very good and she isn’t terribly good’ with computers. She prefers leaflets.
Sue, aged 48, said she wasn’t “great with computers” and, when left alone to watch the TEPI videos at the pre-op assessment, accidentally shut the computer down. She watched them again at home and found it helpful to look at them whenever she wanted a “refresher”. She’d never felt so relaxed before an operation and thought this may have been because of all the information she’d been “armed with”:
The videos had practical rather than gory information, which Sue found good and helpful. She knew what was coming and didn’t feel so nervous.
Like several participants, Mary noted that although the videos and leaflets were helpful and informative, she still preferred face-to-face consultations, using written and video information as a reminder only.
Information about recovery was also important, including knowing what exercises to do, how long recovery would take and when people could work and drive again. Participants were advised to start gentle exercises shortly after surgery when the nerve block had worn off.
Many praised the TEPI exercise video and used it as a guide when exercising at home, Sue saying it was good to watch somebody doing the exercises, and others that the videos helped them to do the exercises correctly. People often showed the videos to their families so that they could also understand what the operation and recovery involved. Mary thought the videos were well done and clearly presented. She used them “many, many times” when she was exercising:
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.
The exercises in visual format were very useful and Alan did them every day. He watched videos on YouTube of the actual surgery.
For Ken, the exercises on the TEPI video and in the booklet weren’t challenging enough, so he looked for more information on the internet (see Wanting more information about shoulder surgery).
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.
People were given a follow-up appointment before they left hospital and many assumed they’d be seeing the surgeon who’d operated on them. They knew little about what would happen at follow-up or who they’d be seen by (see The follow-up appointment for shoulder surgery).