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.

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.

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 shes got, see if she can refer you back again to the hospital.

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.

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 theres 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.

The GP also tried to arrange the appointment with the Nuffield [NHS hospital] but I think they said theres 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.

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.

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.

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.

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.

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.

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-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.

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 shes 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.

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.

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].

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.