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BOOKING AN APPOINTMENT

 

If you have a problem with your shoulder or elbow and want specialist advice contact your general practitioner for a referral letter. An appointment can be made by ringing the clinic secretary Nicola Evans on (01633) 820306 or St. Joseph 's Hospital on (01633) 820300 and ask to make an appointment to see Mr. Kulkarni.

 

THE CONSULTATION

 

Clinics are held on Friday and Monday mornings at St. Joseph 's Private Hospital . The clinics run between 8.40 in the morning and 1.30 in the afternoon. You can expect to spend an average of 20-30 minutes at a new consultation and 10 to 15 minutes at a follow up consultation. Please ensure that you have your general practitioner's referral letter when you attend the clinic.

On arrival at the outpatients desk you will be asked to fill in a form if you have not already done so. This form is to collect the details about yourself, your general practitioner and your insurance details, if appropriate.

At your consultation the discussion will start with your symptoms. This may include how your problem started, the current problems you are having and various other questions to try arrive at a diagnosis. You will then undergo a physical examination. For this you may need to be undressed to a certain extent.

 

INVESTIGATIONS

 

For certain types of conditions like impingement and rotator cuff tears an injection test is often performed to help diagnose the problem. This involves injecting a small amount of local anaesthetic into the subacromial space. The injection stings a little but deadens the area immediately. Steroid is not used for this diagnostic test. Following the injection there are no problems driving or working. In cases of a frozen shoulder it may be necessary to inject the shoulder joint with a local anaesthetic and steroid.

It is possible that further investigations could be performed on the day. These could include x-rays for which you will have to go to the x-ray department at St. Joseph 's Hospital and then return for a consultation with the results on the same day. Blood tests results will be available at a follow-up clinic visit. MRI scans are usually carried out on Tuesdays and Fridays at St. Josephs’ Hospital and a follow-up visit is arranged for you to be seen in the next clinic with the results. MRI scans can also be obtained everyday at the MRI centre in Pontypridd or Cheltenham.

 

TREATMENT

 

Once a diagnosis has been made you will be informed about the condition, its causes and treatment. The risks, benefits and alternatives of the various methods of treatment will be discussed. It is usual to try out non-surgical methods of treatment, as most shoulder and elbow problems are amenable to such therapies. These include injections, anti-inflammatory medications, local treatments including ultrasound, range of motion exercises and muscle retraining and strengthening under the care of the physiotherapist. Only when this fails surgery is contemplated. Mr. Kulkarni refers all his patients to carefully selected physiotherapists in South Wales. The physiotherapists have either worked and trained under Mr. Kulkarni or he has complete confidence in their specialist skills in treating shoulder and elbow problems. Details of the preferred physiotherapists list can be found on the physiotherapy page.

If conservative methods fail then surgery is contemplated. Once again the risks and benefits of the alternative methods of treatment will be discussed. Prior to surgery you will need to attend St. Joseph 's Hospital for a pre admission visit. This visit is to ensure that you are fit for an anaesthetic. You will have a further history taken by the pre-admission nurses, have routine blood tests performed and other investigations as necessary. These may include x-rays, ECG etc. If any problems are noted in the pre-admission clinic Mr. Kulkarni and the anaesthetist are immediately informed

 

MRSA SCREENING

 

In the pre-admission clinic all patients have a number of swabs taken from their nose, armpit, groin and mouth. This is to ensure that you do not carry the MRSA bug. It is not uncommon for patients to be carrying the MRSA bug without any obvious infection. This is an essential part of the pre-admission check up as no patient is admitted to St. Joseph 's Hospital having not been screened for MRSA. This is to ensure that the risk of developing MRSA is kept down to a minimum. In fact no orthopaedic patient has contracted MRSA during their stay at St. Josephs Hospital in the last five years.

 

SURGERY

 

Surgery is normally on a Monday, Thursday or Friday afternoon.

 

You should not eat or drink from 6.00 in the morning.

Generally you will be asked to present yourself at the hospital by 11.00 in the morning.

Once you are admitted you will have a number of visits. You will be pre-admitted by a nurse on the ward, seen by the physiotherapist who will discuss the post operative treatment and reviewed by the anaesthetist. Mr. Kulkarni will also visit you and reiterate the risks, benefits and alternatives and ensure that you are prepared for surgery. The anaesthetists will discuss the various methods of anaesthetic and you can choose the most appropriate method that you are comfortable with. It is possible to be put to sleep completely or to have a regional block so that you are awake during the surgery.

 

All arthroscopic surgery is recorded and a CD-rom will be provided for each patient. Viewing this in conjunction with the live videos in the patient information section will help patients understand their condition.

Following your surgery you will be in the recovery room for an hour or so before returning to the ward. Mr. Kulkarni telephones your next of kin to inform them of the findings of the operation and to reassure them that all went well.

 

FOLLOW UP

 

You will be discharged usually on the same day or occasionally on the following day once arrangements have been made for a follow-up appointment in clinic. You will be seen at two weeks for a wound check and suture removal. Your next visit is generally 6 weeks after the surgery.