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PAGCL Associated with Intra-articular Shoulder Pain Pumps Can Result in Lifetime Disability

Nov 15, 2007 | Parker Waichman Alonso LLP

Post-Arthroscopic Glenohumeral Chondrolysis, or PAGCL, is a debilitating and life altering shoulder injury associated with intra-articular pain pumps used in conjuction with arthroscopic shoulder surgery.  Shoulder arthroscopy is a rapidly expanding field because it offers a less invasive and less painful option for patients.  In arthroscopy, two very small incisions are made, one for instruments and one for a miniature surgical camera to allow the surgeon’s viewing of the area without a large surgical site.  To manage post-surgical pain and extend the deployment of numbing agents, the use of temporary intra-articular shoulder pain pumps was introduced into these types of surgeries.  The procedure involves placing a flexible intra-articular shoulder pain pump catheter into the shoulder joint with the pump remaining in the joint for several days to deliver controlled doses of pain medication, often a combination of bupivacaine and epinephrine.  This course of treatment became popular because it reduced recovery time without the need for narcotic pain relieverse.

But a few days of relief can result in a debilitating and lifelong condition that causes severe—and often, permanent—pain and mobility loss and the need for constant medication.  In some patients, complete loss of the use of the shoulder occurs.  PAGCL, one of the most common complications from shoulder surgeries is a condition where overwhelming damage to the shoulder occurs when cartilage deteriorates following these types of arthroscopic procedures.  Without cartilage, there is no bone-to-bone cushion, causing bones to grind together and resulting in intense pain and, in some cases, chronic arthritis.

A study of 152 patients who underwent arthroscopic shoulder surgeries revealed that 12 of the patients developed PAGCL.  All 12 PAGCL patients received pain pumps during their surgeries; the use of the pain pump was the only factor that the PAGCL patients had in common. In fact, studies suggest that up to 63% of arthroscopic shoulder surgery patients who received an intra-articular pain pump are at risk for developing PAGCL.

In addition to living with acute pain and daily medication, PAGCL may result in a need for follow-up surgery.  Unfortunately, arthroscopic surgery is not an option.  The damage that occurs with PAGCL requires the more painful and invasive shoulder joint replacement surgery (arthroplasty), a more intense surgery option over arthroscopy.  Arthroplasty involves replacing the joint with plastic and metal components.  Surgery lasts two and three hours and patients usually remain in the hospital for three nights.  Physical therapy is almost always required following this type of procedure. Despite surgery, many patients never fully regain use of their joint and some patients report increased pain.

No consistently successful PAGCL treatment has emerged and the damage from PAGCL is believed to be irreversible.  Unfortunately, pain medications seem to worsen the symptoms of PAGCL and offer no long-term value concerning treatment or cure.

PAGCL tends to develop two to twelve months following surgery.  Symptoms include shoulder pain, whether in motion or at rest; increased shoulder stiffness; popping or grinding when the shoulder is in motion; decreased to full loss of range of motion; and loss of joint strength.  Diagnosis of PAGCL is confirmed via an x-ray indicating narrowing of the shoulder joint space and indicating additional surgery is required to replace the destroyed joint.