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Pain Pumps Used in Shoulder Surgery Linked to Cartilage Damage

Jul 24, 2007 | Parker Waichman LLP

For years, intra-articular pain pumps  have been used for pain management following shoulder surgeries.  An intra-articular pain pump catheter is usually placed into the joint by the surgeon during the shoulder procedures.   The small flexible tube remains in the joint for several days to deliver pain medication, usually a combination of bupivacaine and epinephrine, to the shoulder. What many patients undergoing these procedures do not know is that such pumps have been associated with an extremely debilitating condition called Postarthroscopic Glenohumeral Chondrolysis (PAGCL).

PAGCL is the deterioration of cartilage around the joint following shoulder surgery.  Cartilage is the tissue between joints that acts as a cushion to prevent bones from scraping against each other.  When cartilage between a joint deteriorates, the result is extremely painful.   In 2006, a paper was presented at a meeting of the American Academy of Orthopedic Surgeons showing evidence that the use of intra-articular pain pumps could be responsible for this painful condition.  The study looked at 152 patients who had undergone anthroscopic shoulder surgeries.  Twelve of the patients developed PAGCL.  All of the patients who developed the condition 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.  
 
PAGCL is one of the most common complications that can follow shoulder surgeries.
It is extremely painful and can cause life-long disability.  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.  

Treatment for PAGCL is almost always more surgery.  However, many patients never regain full use of their shoulder joint.  Patients who are contemplating shoulder surgery need to be aware of this potential complication.  If they experience any symptoms associated with PAGCL following the implantation of a pain pump, they should seek medical attention immediately.


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