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Studies Link Shoulder Pain Pumps to PAGCL

Aug 8, 2007 | Parker Waichman LLP Recent scientific evidence suggests that the use of intra-particular pain pump catheters temporarily implanted in the shoulder during surgery may be linked to a serious injury know as Postarthroscopic Glenohumeral Chondrolysis (PAGCL). This is an extremely painful condition involving the deterioration of cartilage in the shoulder joint.

Pain pumps are implanted into the shoulder during arthroscopic surgery.  Arthroscopic surgery is supposed to carry less risk and involve less pain than open procedures.   Ideally, arthroscopic surgery should mean a quicker recovery.  Still, these surgeries do require pain killers.  For years, surgeons have favored the intra-articular pain pump for this type of pain management.  These flexible plastic catheters deliver pain medication directly to the joint, and can extend the effectiveness of other shoulder numbing agents for up to 48 hours.

But often, this pain relief comes at a terrible price.  A study published in the July 3 issue of the American Journal of Sports Medicine concluded that these pumps were highly associated with PAGCL.   This association was greatest when the intra-articular pain pumps were used to deliver a combination of the painkillers bupivacaine and epinephrine to the shoulder joint.  It is possible that the high concentration of these painkillers has some association with this problem.   The article recommended that this type of pain treatment be avoided until more studies on shoulder pain pumps and their link to PAGCL is better understood.

Another paper was presented at a 2006 meeting of the American Academy of Orthopedic Surgeons that also showed evidence that the use of intra-articular pain pumps could be responsible for PAGCL.  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.  
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.  PAGCL is one of the most common complications that can follow shoulder surgeries, and it can cause life-long disability.  

The only treatment for PAGCL is more surgery.  Usually, arthroscopic surgery is not an option, and the patient must undergo a more painful open procedure.  Despite this treatment, many patients never regain full use of their shoulder joint.  Patients who are contemplating shoulder surgery need to be aware of this potential complication.  They should speak to their doctors about pain pumps, and they should ask their physicians to avoid the combination of bupivacaine with epinephrine that the American Journal of Sports Medicine linked to PAGCL.  Most importantly, anyone experiencing symptoms associated with PAGCL following the implantation of a pain pump should seek medical attention immediately.

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