Wouldn’t normally ask but this is becoming a major life-changing issue that just seems pushed further back –

Over a year ago Mrs Rider suffered a serious clavicle fracture (five pieces) and we had to wait for second opinions at the county hospital and repeat x-rays to get anything done other than send home with sling which was twice recommended on presentation of the injury (it was tenting the skin, trying to break thu)

They (finally) x-rayed it a third time, this time from a useful angle and promptly admitted her for a plating operation (5 hr). Should be mentioned she has existed bone diseases – migratory osteolysys, osteopena (sp?) – so a special plate had to be order to better ensure the plate stayed screwed into porous bones. They said the operation was difficult but hopefully succesful, and recommended not removing the plate.

Shortly afterwards the continuous pain prompted a further examination by the clinic (registrar this time as surgeon wasnt available) to identify ‘impingement and related shoulder problems’. They gave steroid shot and said wait 12 weeks then we’ll give another in another location if it doesn’t help. Seems like 3-6 month gaps between appointments, referred to physio, then refused physio and re-referred back to specialist, then re-referred to physio like slow-mo table-tennis.

Until the last straw when a month ago she was again referred to a local NHS physio who asked her disrobe and stand square – she finally examined her and said ‘that’s not right’, ‘you need an x-ray before I do anything’ and then x-rayed it that day.

Turns out the shoulder is subluxated (keeps popping in and out) which seems to have been missed for months as when she was examined at the county hospital (they didn’t even require she disrobe, much less physically examine the joint.)

She just feels that the whole thing has been mis-managed, so nearly 18 months down the line she’s going back to see the surgeon today, but has expressed to me she has very little trust in them.

So although she is the most stoic person I know – 18 months of constant pain and immobility, she can no longer drive, can’t work, disturbed sleep is all taking its toll, she finally broke down yesterday. ‘Do we change hospitals, I don’t know, will that be more years wasted, what do I do’?

I suppose what I’m asking is would you change hospitals, would that potentially set her back or not? have you had similar issues, is it unreasonable to think that this situation is worsened by ineptitude/huge gaps in follow-up treatment? Life is on standstill, just a constant round-the clock schedule of making her more comfortable, sling on, sling off, she has to manually re-seat the joint mutiple times daily. Me being decreasingly self-employed and now her unofficial carer/driver, her an unemployed counsellor with no immediate prospects owing to this problem, yet our funds are dried up and just ffs. Of course I keep reassuring her that it will all be fine, we can get it sorted. But secretly – wits end – private care is out fo the question we have lost all of our savings.

*edit subluxated, thnks.

That’s shit, really is. And it must be hard not to be bitter about the possible wasted opportunities to put this right.

However, having said that, I’m’ not sure that changing hospitals/specialists is the best way forward now the physio may have actually spotted the issue.

See what they say today, go in prepared with follow-up questions, written down if necessary, and don’t be shy about asking for a second opinion if the latest developments aren’t taken seriously.

Turns out the shoulder is sublocated (keeps popping in and out) which seems to have been missed for months as when she was examined at the county hospital (they didn’t even require she disrobe, much less physically examine the joint.)

That would be subluxed. There are a few reasons that a shoulder would sublux. The main one that I would think of would be poor muscular control of her rotator cuff. This is something that may well have taken a long time to develop and may not have been missed as it may simply have developed over time. The impingment related shoulder problems would back this up.

The slo-mo table tennis thing happens regularly – Drs have final say over who they treat and how, but so do physios, so if either thinks that the patient is inappropriate for their service then they’ll refer them back.

I wouldn’t jump on the huge gaps in treatment/ indeptitude conclusion straight away. Stick with the people who have been seeing your wife and if things dont improve get a second opinion. Assuming that the hospital has more than one orthopaedic consultant there is no need to change hospitals.

It might be worth speaking to someone about getting a shoulder subluxation brace to try and reduce the incidence of repeat subluxation.

I know this might sound daft but at work, if you have parties that aren’t working well together you get em in the same room at the same time to agree the way forwards. Is that a possibility?

I gave up on the NHS and went private as I got fed up with the long waits between the various disciplines.

I hear what you say about being skint, but we had much the same when my wife damaged her knee, brushed off by A&E, long wait for a fracture clinic appointment when we kicked up a fuss so we researched private consultants with a particular specialism and went direct – £140 for the first consultation. With an appropriate note from the consultant to GP we got on to his NHS list for the operation and after care. I have to say, we’ve been underwhelmed by the competency of the NHS Physio service who’s work seems principally to consist of printing off exercises from the interweb that we’ve already discovered – gone private there as well at £45 a pop but only when needed.

The NHS seems to have got itself into a position where it assumes that the patient has an infinite amount of time to resolve the issue without regard to other consequence hence the interminable gaps between various appointments, oh and interdepartmental communication is crap and turf warfare rife!

Keep pushing, you’ll only get the treatment you need by persisting. Ask to be referred elsewhere, try and get some specific consultants names/clinics. My mother was in agony for 7 months and couldn’t move, NHS/GPs just kept stalling and stalling. She nearly missed my wedding which would have broken bother our hearts.

I have to say, we’ve been underwhelmed by the competency of the NHS Physio service who’s work seems principally to consist of printing off exercises from the interweb that we’ve already discovered

What exactly do you think physiotherapy is?

I’m so sorry to hear this.

At our local hospital the physios finally got the surgeons/specialists to start listening to their concerns. e.g. starting physio earlier than normal, to help prevent future problems (on some patients). This took ages as many specialist are old school and their word is final. A new younger surgeon agreed to the new ways and things are working out for the better. Unfortunately this came about too late for me. My nhs physio was quite cross at the fact I’d been left too long to be seen and my treatment ended up with many hospital visits and time wasted, all this could have been avoided if there was more consulting. She feels there should always be a physio in the fracture clinic with the patient. Costly at the beginning but ending up saving much money and distress further down the line.
I have been messed around by x-ray departments and fracture clinics for 2 years now but stress I am no where near the state your wife has been left in.
It seems they have a ‘one list fits all’, not taking into account fitter patients, or different needs.

To answer your question. I would stick with your current specialist but be firm and have questions at the ready.

Good luck.

What exactly do you think physiotherapy is?

I’d expect an inspection of the problem area, however cursory and some discussion of the issues and how the exercises would address them!

If you didn’t get that then you’ve been seen by an incompetent physio and you should complain about it. Don’t go tarring all NHS physios with the same brush though. The best physios I know work in the NHS – some of the worst work in private practice.

Before you go private, where you will probably see the same surgeons, but in a more plush environment or start again in another hospital, try and explain your concerns to your current team. You state you saw the registrar, now the registrar will be working for a consultant and what I would suggest is speaking with her consultant and explaining your concerns as you have done here. Most consultants will have an NHS secretary and will probably be contactable through the hospital switch board or contactable through the clinic. If no joy this way there should be a clearly signposted complaints procedure, who will Pont you in the right direction. NHS hospitals aren’t in the business for failing patients, but occasionally things go wrong and by highlighting concerns most trusts will bend over backwards to put things right.

Thanks everyone for all the good sense, anecdotes and well-wishes, really appreciated. I passed them all on of course, she had a big smile.

See what they say today, go in prepared with follow-up questions, written down if necessary, and don’t be shy about asking for a second opinion if the latest developments aren’t taken seriously.

^ This pretty much is what happened. Hopefully positive developments – the consultant was ‘surprised’ to see her shoulder in this state (what the holy…?) also asked her what ‘she was doing in an immobilising sling?’ (‘Well, at the last appt with the registrar he recommended she continue to use it when the pain is bad’) 😐

So the upshot yesterday: Mrs MR has been referred her to a shoulder specialist , and the consultant also ordered an MRI scan which he described as ‘urgent’ < (I have no mental energy to even unload a hollow laugh) so now back to waiting for both scan and appt. Thnks for the advice folks, she didn’t jump straight in with ineptitude accusations, although tempting. Think a complaint procedure through the correct channels is in order though, if only for the lack of communication between specialists. Frustrating isn’t the word – beyond the worry of having to save a shoulder it could take year/s of physio.

Bunnyhop I think you’re spot on with identifying early physio as a potential saver, both of mobility and long-term cost/independence/employability. Hope you’re healing well now?

If you do have further issues with the treatment then ring the hospital and ask for their PALS service. This is a patient advocacy service that can help address care issues and might save you lots of frustrating phone calls etc.
If it goes further and you want a different hospital then RNOH Stanmore is staffed by extremely talented people but be prepared the wait will be long (but in my experience worth it). They take on cases that district hospitals cannot manage.

Feel for you. August 2013 MrsMC broke her left index finger. We live close to one of the top hand units in the country.

It’s been pinned and/or wired 3 times. It’s still broken. She’s just finished a two month course of industrial antibiotics with all sorts of lovely side effects as the last wire got the bone infected. Only remaining option if she can’t stop knocking the broken finger (on a hand she doesn’t have full control of due to cerebral palsy) is to remove it.

Sorry, that now looks like a self indulgent rantette

Hi im not sure if this is any help to you….. I’m in work so I’ll keep it brief.

I suffered catastrophic damage to all the ligaments and tendons in shoulder. ( no break though ). I had a series of ops including bolts and ligaments to hold everything together. ( some of which have failed) It’s been 5 years of agony and pain. The best treatment however has been joining the gym and spending a lot of time working on the surrounding muscles. It is not subluxed now and seems a lot more secure. The pain is still there and working on it has been agony but the results have been promising.

I’ve spent months under different physios. If you would prefer to talk over the phone. We could arrange that.

After dislocating her shoulder 2x trampolining (old enough to have known better) Mrs G asked for a referral from wakefield to see Len Funk (specialist shoulder surgeon) at the wrightington hosp /clinic all through NHS. all done and dusted now she did go 100% following physio instructions well (110%) has been good ever since. search for ‘shoulderdoc’ lots of info there. hope things improve soon.

Leonard Funk is a great bloke. If anyone can fix a shoulder he can.

Bunnyhop I think you’re spot on with identifying early physio as a potential saver, both of mobility and long-term cost/independence/employability. Hope you’re healing well now?

Thanks Malvern Rider.
My shoulder is virtually sorted out now but it’s been a long slog – 20 months to be precise.
I have since broken my hip, which is another scenario entirely. Luckily this time with the experience we gathered from the cock ups of my broken arm (humerus at ball and socket), I was able to get sorted asap, possibly too soon, as I seem to have put myself back again trying to do too much too early and pushing myself too hard. The nhs this time round have been so much better.

Good luck with the new treatment. I’m sure you will get sorted soon.

The RNOH is a fantastic place, they replaced one of my friends hips and revised the other within a week of each other after another hospital were reluctant to due to a history of heart attacks and AAA.
Everyone from prof Hart to the nurses to the physios were brilliant.

It really spoilt us in seeing how great hospitals can be when all the staff seem to care.

And pals is a waste of time in my experience, it’s sold to you as a there for the patience benifit but in my experience they are there for damage limitation on behalf of the hospital.

I wish your wife well and hope she gets the care she deserves.

Thnks again to all from Mrs R for the well-wishes and advice. Sorry to hear about yr hip BH, glad you got fixed up – you are Evel Knievil and I claim my folding dosh!

Quick update – nearly a month on and has so far had a referral to see shoulder specialist (local hospital) following scan (next week) and nerve conduction test which was last week – she got tasered by them and apparently the nerve is working. I apparently enjoyed the tasering rather too much 8)

So it looks like could be more a structural issue following the clavicle fracture/repair. Not great news, and still some way off to see the shoulder specialist (mid-July)

Seems an awful long term to be sitting around with a shoulder popping in and out (working on the assumption that waiting proportionally decreases the chances of effective repair?) she needs 24hr care now which I am happy to be able to provide – but the endless waiting. She decided against traveling to manchester in first instance in favour of seeing what they say at local County hospital, hope it was a good choice, but ye gods is it sloooooow.

itsmygame – kind offer of yrs thnks, any way to get in touch with you? cheers MR

If it goes further and you want a different hospital then RNOH Stanmore is staffed by extremely talented people but be prepared the wait will be long (but in my experience worth it). They take on cases that district hospitals cannot manage.

Depending on geography, there are other specialist orthopaedic hospitals, eg. Wrightington or Oswestry.

Assuming that the hospital has more than one orthopaedic consultant there is no need to change hospitals.

On the UK mainland, I’d be very surprised if there are fewer than 7 or 8 consultant orthopods; issue may be how many of them do elective shoulder work though as there are fewer upper limb surgeons than lower limb surgeons (eg. in my place, it’s 3/12).