The follow-up appointment for shoulder surgery
- Age at interview:
- David is married with four adult children. He owns a small company. Ethnic background: White.
What happened when you went for your follow-up appointment with … who did you see?
I saw the physio, yeah, very nice lady, very thorough, and she also showed me some exercises and things to do when I go to the gym. And which exercises to stay away from and which ones to do, like stay off the cross trainer and things like that because it’s moving. And also to set my body before I exercise by putting the shoulders back and, because otherwise muscles compensate when you do the exercise.
So that was very good and, as I say, we’ve, she’s given me a number and we’re going to, if I need to, I’m going to go back in a couple of months. I feel as though it will settle down on its own, but if it doesn’t then I’m going to make an appointment and go back and see her.
Okay, so you have joined the gym?
Yes, I’ve gone, yes I belong to a gym and I’ve gone back to the gym again.
Okay, and you’re following sort of kind of her advice regarding what to do and what to avoid?
Yeah, doing a lot more with, on certain machines to work the upper shoulders and arms.
Can you tell me which machines you are working on, I mean it’s just for them to just find out when people look at the website?
Running again, cross trainer, cycling and then light weights on some of the machines. She told me not to do the press, that one where you push so certain, that one and there’s a lateral press that you’re doing, that one, not to do that one as well.
- Professor of Orthopaedic Surgery and Musculoskeletal Science; Academic Consultant Shoulder & Elbow. Botnar Institute of Musculoskeletal Sciences. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
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.
- Age at interview:
- Margaret is married, has no children; retired. Ethnic background: British.
You said you hadn’t had your post-op assessment?
And do you know when you’re going for that one?
[Looking at paperwork] 14th August.
Do you know much, what do you expect will happen on that day?
I haven’t got a clue. I just presume they’ll ask questions and see how the arm moves and that’ll be it. I’ve no idea.
Okay, you haven’t been told anything about that at the moment?
No. Do they do things to you then?
I don’t, I don’t know.
Oh, okay [laughs].
Is there anything you’d like to happen or you want to find out at that appointment?
Just that it’s going on as it should do. I feel as if it is with the different things I’m able to do now, which I haven’t been able to do for a long time. And I’m automatically doing things and, ‘Ah, I haven’t done that for a long time.’ So it’s quite nice.
Jenny wanted to see the surgeon at the follow-up appointment so she could ask if her other shoulder could be operated on. She’d been having pain since her operation and was unsure why. An appointment with the consultant would have helped her find out what was causing the pain and what the doctors could do to help.
- Age at interview:
- Jenny is divorced and has three children, aged 39, 37 and 34 years old. She works full-time as a support worker. Ethnic background: White British.
I was expecting to see the doctor, the surgeon, but I didn’t. I only saw [the physiotherapist] because they was on about doing the left hand shoulder as well. But now I don’t know if they are going to do it or whether they are thinking of doing it or what because nothing’s been said. But it needs doing. They know it needs doing. He’s agreed, he’s confirmed that one but if they’re going to do it, I don’t know.
Why were you expecting to see the surgeon?
Well, because he did the operation so he would have seen inside my shoulder and he could have explained to me, you know, what he’d seen and what they’d done and, you know, in wider terms.
And the person you saw, was she able to explain to you?
She explained what she thought had happened and she did get me into a position where we managed to lift my arm up with pillows and things under my shoulder. But it’s not easy to do that on yourself when you’re in bed [laughs], to try and relieve the pains. So consequently I’ve been getting very little sleep and I’m spending most of the night in the armchair because I just can’t lay with the pain.
So what you were expecting and wanting was to see the surgeon
For him to explain what...
Well, yeah and to find out when and if he was going to do the left one. So, you know, I’ve been left with a question now.
At her six week follow-up appointment, Mary found out that she’d been doing one of the exercises incorrectly. She would have liked to have seen the physio sooner. Even though she’d looked at the exercise booklet and watched the TEPI exercise video, she’d found it hard to copy the exercise. At follow-up, Mary had her shoulder strapped up to help correct the positioning. After the tape came off, she started the exercises again and felt much better. Soon afterwards, though, she started having ‘episodes’ of severe pain that were sudden and ‘excruciating’. The pain eventually settled down but Mary would like to know what is causing it and if it’ll stop. She has another follow-up appointment arranged but is unsure if she’ll see the physio again or another professional.
- Age at interview:
- Mary is married and has three children. She works part-time as a beauty consultant. Ethnic background: White British.
What she did at the follow up was to put this quite major taping on, which pulled it sort of up and back. And she said, “That’s the position it needs to be in. So if you can keep that on for a few days then it’ll help the brain dictate that that’s where the shoulder needs to be.” ‘Okay, this is fine.’
So off I went and by about the time I’d walked out of the NOC [Nuffield Orthopaedic Centre, NHS hospital] building in to the sort of atrium area there, it really was quite painful. So I thought, ‘Oh gosh, I’m supposed to be driving home.’
So I went and got a drink and took some pain relief there. By the time I got, I then drove back. By the time I got back, it was really shouting at me to sort of say, you know, “What’s going on?” and you know, you just think, ‘How can I be in such a, you know, how can just sort of repositioning this be, sorry how can it have got in to be quite so far, not the wrong place but you know what I mean.
So sort of back on pain relief and doing my best to do these exercises and, having being shown that where to put my arm and shoulder in this position, well having been shown and felt what the correct place was to do this exercise, I just found it incredibly difficult to read, to be able to do it myself. Although I knew what I should be doing, I just found it very, very difficult to actually recreate the same I’d been shown on that day. So I just carried on sort of doing it as best I could.
And after about a week, I can’t remember exactly, I took the strapping stuff off, the tape off, and carried on with the exercises and again, you know, improvement, got much better. Complete, really completely pain free until about ten days ago when again something, did something, don’t, still don’t know, it was getting up in the morning. So I mean it wasn’t, you know, it wasn’t doing anything majorly different to out of normal, and got this real sort of excruciating, excruciating pain in the shoulder again. And back to this sort of thing of, you know, shoulder dipped and things.
- Age at interview:
- Alan is married and has two adult children. He is a librarian and works full-time. Ethnic background: White British.
Have you had your post-op assessment, your follow up appointment?
I did, yeah. That must have been the one that I had most recently then when I saw the physiotherapist. Yeah, I think it was. That was the lady that was in the TEPI [videos]. Yeah, so I have had that, yeah.
And what happened at that appointment?
She looked at all the movements and asked how things were going and, you know, looked, we tried touching the ceiling sort of things. And she did spot that I’ve got this bad shoulder blade posture or something. So instead of like keeping your shoulder back and reaching for something, I’ve got a bad habit of like pushing my shoulder forward, which is not very good apparently.
So she strapped me up to try and get it pulled back, which was, actually helped. It’s a bit uncomfortable with a big strip of plaster but it came off after about a week. So I’ve probably gone back to it. I’ve sort of consciously tried to keep it back but, in reality, I expect I’ve gone back to how it was before.
Yeah. And was she happy with everything else? Everything else was okay?
- Age at interview:
- Patricia is married and has three adult children. Retired social worker. Ethnic background: British.
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.