Frequently Asked Questions
Do I need a referral letter?
Most healthcare insurers require a referral letter from your GP or therapist prior to approving your specialist treatment. This is unnecessary if you are funding your own treatment although it can be helpful.
What do I need to bring to my appointment?
It is helpful to bring details of previous treatment that you have had with you to the initial appointment. Alternatively, please contact my secretary so that the relevant details can be obtained prior to the appointment.
Can I use my medical insurance for treatment?
I am a registered provider as a Consultant Orthopaedic Surgeon specialising in shoulder and elbow surgery for all of the main healthcare insurers, including AXA PPP, BUPA, Aviva, Vitality Health, WPA, Simplyhealth and CIGNA. You should contact your insurer to obtain authorisation for the consultation and any subsequent treatment, and to make sure that any fees incurred will be covered by your policy.
Can I be treated without medical insurance?
You are able to self-fund your private treatment if you do not have medical insurance cover. Most private hospitals offer package ‘all inclusive’ quotations for most common shoulder and elbow surgical procedures, which include pre-surgical, inpatient and post-surgical care. Please contact us if you require a quotation for consultation or treatment – the hospitals can also be contacted directly to obtain package quotations.
What can I expect if I have a steroid injection?
- Steroid/cortisone injections are often used in the shoulder and elbow to reduce inflammation and pain in several conditions. They are usually performed either in the clinic or in the operating theatre, and sometimes with image guidance such as ultrasound or X-ray to target certain areas. They are often worthwhile trying although their effectiveness is variable, with pain relief lasting from several weeks to many months in some instances.
- The steroid/cortisone is usually combined with a local anaesthetic medicine when injected which usually has an immediate pain relieving effect. This usually wears off after several hours and may cause the shoulder or elbow to feel ‘bruised’ and ache for 24-48 hours. It is advisable to avoid strenuous activity during this period – the benefit of the steroid/cortisone is usually felt after this period and normal activities can be resumed.
- Complications are extremely rare after steroid/cortisone injections. The risk of infection is approximately 1 in 10,000 and may manifest itself by increasing pain, redness and swelling around the injected joint with a high temperature. In diabetic patients, the injection may cause a temporary rise in the blood sugar for 24-48 hours, which should be closely monitored. Repeated injections may cause thinning of the skin and tendons around the area, so it is advisable to limit the number of injections to three per year.
What can I expect before surgery?
- Once we have made the decision to proceed with surgery, a preoperative assessment will be arranged. The purpose of this is to ensure that it is safe to go ahead with the surgery especially if a general anaesthetic is required. The assessment will usually involve several blood tests, an ECG (heart tracing) and possibly even specialist tests such as heart scans or lung function tests.
- As the date for surgery approaches, arrangements will be made for you to be admitted to the ward usually on the day of surgery. You should not eat or drink anything for at least 6 hours prior to the surgery if having a general anaesthetic. It is important, however, to take your regular medications with small sips of water unless asked otherwise by the preoperative assessment clinic. Jewellery such as rings on the side of the surgery should also be removed due to the small chance that the hand may swell after the surgery potentially causing tightness. I will see you prior to the surgery so that we can recap the details of the operation and complete the consent form. The anaesthetist will also assess you prior to surgery to ensure that it is safe to proceed on the day and to discuss the details of the anaesthetic.
- Most shoulder surgery and some elbow surgery is performed under a general anaesthetic with a nerve (interscalene) block which involves an injection around the neck region. The block provides excellent pain relief after surgery and is usually performed by an experienced anaesthetist using ultrasound guidance. It usually keeps the shoulder and upper arm feeling numb for up to 24 hours and it is therefore important to protect the arm carefully in a sling during this period to prevent any damage occurring to it.
What can I expect after surgery?
- Once the surgery is completed, the shoulder/elbow will usually be placed in a sling – the amount of time required in the sling will depend upon the specific procedure performed and will be discussed at your appointment. You will wake up in the recovery area and then be transferred back to the ward after a short period of monitoring. I will then see you on the ward to discuss the details of the surgery with you.
- You will be seen by the physiotherapist on the ward before discharge for the initial rehabilitation instructions. Most patients are discharged either on the same day or the morning after surgery, as long as the shoulder/elbow feels comfortable.
- You will usually have a large padded dressing after keyhole shoulder surgery, which can be removed in 24-48 hours after surgery leaving smaller dressings beneath it. These dressings should be kept dry for 2 weeks and undisturbed to reduce the risk of an infection. No sutures are used for shoulder arthroscopy wounds – other wounds may have dissolving sutures that do not require removal. I will see you in the clinic approximately 2 weeks after surgery for follow up to remove the dressings and check that the wounds have healed.
- Outpatient physiotherapy commences soon after discharge from the hospital and is a vital part of the recovery process to ensure the best outcome after the surgery and restore good movement and strength. This is usually tailored to the individual in terms of numbers of sessions and amount of guidance required.
- Driving is usually restricted until you are free from the sling and the shoulder/elbow feels comfortable.
- The amount of time it takes to return to work is dependent upon the type of work and the type of surgery performed. Most activities can be resumed after 6 weeks and light work started as early as 2 weeks. It may, however, take several months to return to heavy work that involves significant lifting.