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Patient Journey

Prior to your admission

Your admission will be coordinated by Michele Elwill, Alistair’s Practice Manager, in combination with the hospital’s own Admissions team.
  • Michele will personally confirm your admission date and time, and instructions on starvation details (not required for local anaesthetic operations)
  • The hospital Admissions team will organise a telephone or face to face pre-operative assessment, dependent on your age and any underlying medical conditions.

Surgery

If surgery is being performed at the Three Shires Hospital this is usually on a Monday or Wednesday, and if at the Ramsay Woodland this is usually a Saturday. All patient accommodation is in private rooms, with en-suite bathrooms.

Most operations are performed as Day Cases (some bigger or longer operations may require an overnight stay). Local Anaesthetic operations may be performed in the Outpatient Minor Operating Suite or sometimes in the main theatres.

Once you are admitted you can expect a number of visits. The ward nurse will admit you, the physiotherapist will discuss post-operative exercises, the anaesthetist will discuss the anaesthetic your anaesthetic (General anaesthetic and/or Regional anaesthetic block), and Alistair will further review you and check you are marked and consented.

You should take your usual medications e.g. blood pressure tablets on the morning of surgery with small sip of water. Instructions for other medications such as anticoagulants (blood thinners) or HRT will be given to you when you attend for your pre-assessment, but in general these should be stopped in advance of surgery (if safe to do so).

Please take off any rings from your hands before coming to hospital (helpful video). If the ring still cannot be removed, then please see a jeweller who should be able to cut this off for you. The reason for this is that following any surgery to the upper extremity, swelling tends to accumulate in the hand and fingers and a tight ring can compromise the circulation to the finger tip.

After Surgery

Before your discharge from hospital Alistair will review you to discuss the details of your operation and pass on any specific instructions. For most upper limb operations a regular arm sling is fitted, but on occasion a more specialised FormFit sling will be used. These can, at first, seem complicated but the physiotherapists will show you how to apply and remove these (*video), and also instruct you on some immediate exercises before you see your physiotherapist back as an outpatient. The nursing staff will ensure you understand how to manage your wounds and the dressings and that you are discharged with appropriate pain relief.

It is common for the operated arm and sometimes even the hand and chest wall to remain numb overnight; this is due to the lasting effect of the anaesthetic block. Sometimes you may also feel you can’t quite take a full breath as the anaesthetic block temporality weakens your diaphragm.

Similarly swelling and puffiness of the upper limb following surgery is usual; this usually last a few days but may last up to a few weeks.

There may also be some clear, pink or even red fluid coming from the surgical wounds, this is not infection or bleeding and merely represent some of the fluid used in the shoulder arthroscopy making its way out (fluid discharge is most common from the surgical wound at the front)

As soon after surgery as possible you should start to ice the operated area; in the case of the shoulder a Iceband (video) is something Alistair recommends (this is a contoured shoulder ice pack which is offered to all patients for purchase by the hospital physiotherapists (£25-30) the cost of this is unlikely to be covered by your private insurance).

Wound Care

To minimise the risk of infection, your wounds should be kept dry for 7-10 days. The dressings applied immediately following surgery are sterile and do not need to be changed unless they lose their stick or become wet (if they have lost their adhesion to the skin they may well be changed before you leave hospital). Although mostly waterproof dressings are used, experience suggests they are not 100% waterproof and therefore it is best to avoid directly showering on the wounds. Consider protecting the wounds with a large piece of cling film, and/or using a hand held shower and avoiding the area.

For shoulder surgery there is usually one deep dissolvable stitch per keyhole wound, and this is reinforced with 1-2 steristrips (sometimes also known as ‘butterfly’ stitches) – these steristrips can be peeled off after 10-14 days (easiest after a shower or bath).

For other operations there is often a non-dissolvable stitch (recognised by its blue colour); this will normally be removed at your first follow up appointment.

Follow Up

Physiotherapy and/or Hand Therapy frequently forms an important part of you rehabilitation and arrangements will usually made for these to commence at an appropriate interval after surgery (Alistair will write to your therapist with the details of your operation and a plan for you). Whilst Physiotherapy is almost always covered by medical insurance, the total number of sessions may be limited; regrettably not all insurers cover Hand Therapy; it is important to be aware of any such restrictions before your operation.

Alistair will always be available on his mobile out of hours should there be any post-operative problems which the ward staff or duty hospital doctor are unable to help with.

Recovery

The time required for recovery following surgery will vary from person to person and depend on the severity of the condition and the surgery performed. The period of time which you need to wear the sling after surgery will also vary, but the times below offer a rough guide for those undergoing shoulder surgery:

  • Subacromial decompression: 2-3 days
  • Subacromial decompression with Acromio-Clavicular Joint (ACJ) excision: 3-4 days
  • Rotator cuff repair (small): 3-4 weeks
  • Rotator cuff repair (large): 5-6 weeks
  • Shoulder stabilisation/Labral repair: 3-4 weeks
  • Acromio-Clavicular Joint (ACJ) stabilisation: 6 weeks
  • Clavicle or Shoulder fracture: 4-6 weeks

Outcomes from surgery

We think it’s very important that we objectively track the progress of your treatment in order to ensure you have the desired outcome from treatment. Before your procedure, therefore, you will invited to set up a secure web-based profile for yourself which is then used to record outcome scores, termed PROMs (Patient-reported outcome measures). This gives you the opportunity to provide important feedback about your procedure and allows us to continue to monitor your health after you have been discharged.

It is now becoming increasingly important to capture PROMs at all stages of your progress and treatment. Many hospitals and clinicians are now mandated to do so. Gathering the most accurate information is best achieved using a system where patients, healthcare professionals and healthcare providers work together to ensure that it can be used to improve services, treatment and the quality of care that you receive.

Returning back

You should not drive until the your arm is out of the sling and your pain has subsided to the extent that you are not taking regular pain killers .You should never drive while taking Tramadol or other strong painkillers. Additionally you should be able to place your hands on the steering wheel between 3 and 9 o’clock positions, and be able to safely swerve to avoid danger. Above all, you need to feel confident in your own ability to drive; if you feel that your ability to drive has been affected, you are required by law to contact the DVLA.

The DLVA advice includes the following:

  • Drivers have the legal responsibility to remain in control of a vehicle at all times
  • Drivers must ensure they remain covered by insurance to drive after surgery
  • Notwithstanding any restrictions or requirements outlined in other chapters of this document, drivers do not need to notify the DVLA of surgical recovery unless it is likely to affect driving and persist for more than 3 months.

The period which you will be off work will depend on your condition and the type of work that you do. Generally, most patients can usually return to work within 2-3 weeks, if doing a ‘low demand’ type of work. There will still be restrictions on lifting and overhead however. Those doing more physical work, or jobs that repetitive upper limb tasks, will require longer periods off – up to 6 weeks for a simple shoulder operation, and up to 3 months after a larger operation, such as a rotator cuff repair.

This is very dependent on the operation performed. Alistair will try to give you some idea of this during your consultation before surgery, but the findings at the time of surgery may alter the timings.

You will, of course, work closely with your physiotherapist after surgery and once certain milestones are reached, in terms of range of motion and strength, then a progressive return to your sporting activities will be possible.

 

What Our Patients Say

Incredibly gifted surgeon, I am impressed with the success of my operation which has given me back a full range of movement enabling me to resume sport and everyday activities. Outstanding, I would highly recommend Mr. Alistair Jepson.
Frozen Shoulder, Shoulder Pain
From start to finish it was a very smooth journey to diagnosis to post-op care. Dr Jepson provided all the details and information I needed in layman’s terms. He was also very kind when I was distressed before the operation. Most importantly he fixed the issue in my shoulder - after 8 years of pain and discomfort I am now completely pain free and completely comfortable! Thank you Dr Jepson and team.
Shoulder Pain
Perfect. Very knowledgeable and I get instantly at ease and the procedure went exactly as I had hoped.
Bone Spurs, Shoulder Arthroscopy
Everything was clearly explained beforehand. The operation went smoothly. The recovery was as expected.
Shoulder Pain, Rotator Cuff Injury, Sports Injury
Undoubtedly the best at what he does. He’s worked on and fixed both of my shoulders now. Each time has been exceptional.
Sports Injury, Shoulder Pain

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