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PAGCL Often Follows Use of Pain Pumps in Shoulder Surgery

Jul 27, 2007 | Parker Waichman LLP

Shoulder surgery can be a particularly painful ordeal, and pain management is an important part of the treatment process.  Intra-articular pain pumps are one of a number of techniques used for managing pain.  Use of the pump is thought to prolong the effects of other numbing agents for several days.  Unfortunately, this relief often comes at a cost.  Evidence is growing that use of these devices has been associated with a painful condition called Postarthroscopic Glenohumeral Chondrolysis (PAGCL).

Intra-articular pain pumps are implanted into the shoulder joint during surgery and release pain medications directly to the joint.  In most cases, the pumps do what they are meant to, and offer patients effective pain control.  However, some patients experience PAGCL, a progressive loss of cartilage in the shoulder joint following this surgery.  For a long time, physicians were unable to determine what caused this damage.  Last year, one of the first studies to look at this problem was published.  The study looked at the medical charts of 152 patients who had undergone anthroscopic shoulder surgeries.  Twelve of the patients developed PAGCL, and all of them had received pain pumps during their surgeries.  The use of the intra-articular pain pump was the only factor that the PAGCL patients had in common.  While this analysis is not conclusive, it does point to a need for more investigation of this problem.
PAGCL is extremely painful and can cause life-long disability.  Cartilage is a flexible tissue that cushions the bones of a joint.  If cartilage is lacking, the bones will grind together.  The result is extreme pain, and sometimes chronic arthritis.  Symptoms of PAGCL include pain at the shoulder when it is in motion or at rest; increased shoulder stiffness; popping or grinding when the shoulder is in motion; decrease in range of motion; and a loss of strength in the joint.  PAGCL is usually diagnosed with an x-ray showing the narrowing of the shoulder joint space.  

A patient diagnosed with PAGCL usually has to undergo more surgery.  However, surgery does not always provide complete relief, and patients can end up with more shoulder pain than they had prior to their initial surgery.  Anyone contemplating shoulder surgery should discuss pain pumps with their doctors, and they must notify their physicians if they experience any of the symptoms associated with PAGCL.

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