What happens on the consultation day?
You will see Mr.Prasad in the outpatient clinic and he will ask you the details regarding your shoulder / elbow problem, its impact on your day to day activities, general health, medications and allergies. He will then carry out detailed clinical examination following which he may request some relevant tests. The commonly requested tests are plain X-rays, Ultrasound scan or MRI scans. You will be directed to the radiology department for these tests. If there is a slot available for scans then it may happen on the same day if not you will be given an appointment for another day.
What happens on the follow up appointment day?
Mr.Prasad will review the scan results and then discuss the available treatment options for your problems. Treatment options could be steroid injections, physiotherapy or surgery depending upon your clinical condition. If you decide to go for surgical treatment then you would be given all the information about the procedure including pros and cons, post-operative rehabilitation and recovery time. If you decide to go for surgery you will then be required to sign a consent form for the planned surgery. You will also be given an opportunity to think about surgery and return to clinic at a later date if required.
What happens once surgery is agreed with Mr.Prasad?
Mr. Prasad will arrange your surgery date and the hospital will then get in touch with you, closer to the agreed date to arrange a pre-operative check-up. This will either be a telephonic conversation with you for minor procedures or a formal assessment by a specialist nurse who will also organise appropriate tests as per your general health. This will include a blood test, ECG i.e. tracing of your heart and swabs from your skin. If any special tests are required, you will be directed accordingly. The preoperative team will work closely with the anaesthetic team and Mr Prasad to ensure that all necessary tests are performed to a satisfactory level and your general health is optimal prior to your scheduled surgery date.
The hospital will also inform you regarding the arrangements for your surgery. The surgery will be scheduled at a mutually agreed location either at the BMI Alexandra hospital or the BMI Highfield Hospital.
On the day of surgery
The approximate time of arrival on the day of surgery will be communicated to you by the hospital. You must not eat or drink or chew gum for 6 hours prior to the time of surgery. However, you may be allowed to have clear drinks (water or black tea) up to 2 hours prior to the proposed surgery. This can be discussed further with the anesthetist. You should take your usual medications (unless directed otherwise) on the morning of surgery with small sip of water. Jewelry (including rings) should be removed from the arm that is to be operated on. This is for infection control purposes and to avoid constriction in the event of swelling that may occur following surgery.
The nursing staff on the ward who will assess you and go through a checklist to see that everything is in place and your safety and comfort is ensured at all times. Mr Prasad as well us the consultant anaesthetist will see you on the day and confirm the procedure and the arrangements for the surgery. Your limb will be marked and the procedure will be re-confirmed by Mr Prasad. The theatre personnel will then take you to the operating theatre where the consultant anesthetist and the theatre team will greet you. They will then proceed with a routine safety checklist to confirm your identity, type of surgery and the site of surgery. The team will then administer the appropriate anaesthetic which is normally a general anaesthetic where you will be put to sleep by injecting a liquid using a cannula (thin plastic tube) inserted into your veins, usually at the back of your hand. The anaesthetist might offer you a nerve (interscalene) block injection as a part of anesthetic procedure. The nerve block is a small ultrasound guided injection in the lower neck, given after you are asleep, that numbs the shoulder and the arm. This provides very good pain relief during and for several hours after the operation. This means you will have very little or no sensation and strength in your arm until the effect of the nerve block wears off. It is important therefore that you keep your arm in the sling. The anaesthetic team will stay with you at all times during the procedure to ensure your safety and comfort.
Information leaflet on nerve blocks
What will happen after a surgical procedure?
Following surgery, the specialist recovery nurse and the consultant anaesthetist will shift you to the recovery room adjacent to the operation theatre where you will be looked after. They will monitor you and ensure that you are comfortable with adequate pain relief. Once your general condition is optimal, you will be shifted to the ward to allow full recovery. You are expected to wear a sling to support your arm following the surgery and the duration of the sling depends on the type of surgical procedure. You may have to wear the sling even in the night in certain cases depending on the type of procedure. Nursing staff will be advising you on the care of your arm in the sling. A physiotherapist will review you on the ward and will advice you on the exercises you have to do after surgery. After shoulder arthroscopic surgery there will be a large absorbent dressing over your shoulder, which can be removed after 24 hours. The actual wound will be covered by a small dressing, which should not be changed unless it is wet. In order to reduce the risk of wound infection, the surgical site should be kept dry for the first 2 weeks following surgery. The length of stay in hospital could vary from few hours to few days depending upon the complexity of surgery, general health of the patient and post-operative recovery. Painkillers will be prescribed to take home. The wound dressing is usually removed in 2 weeks time in clinic.
What happens after discharge?
Follow-up appointments with the physiotherapists and Mr. Prasad (usually at 2 weeks) will be made at the time of discharge. If you have any outstanding or new concerns while you wait for your follow up appointment, you could either contact Mr. Prasad’s medical secretary- Deborah Shipley ( Phone: 07479831557) or Mr. Prasad directly for non-urgent concerns (Email: firstname.lastname@example.org). If you would like to rearrange your follow up appointment date or have not received one, you should contact the hospital directly and arrange a follow up as advised by Mr. Prasad’s team at the time of discharge.