http://www.yourlawyer.com/topics/overview/pain_pump_shoulder_injury Sat, 21 Nov 2009 06:43:33 -0800 pixel-app en http://www.yourlawyer.com/articles/read/13330 Thu, 15 Nov 2007 00:00:00 -0800 http://www.yourlawyer.com/articles/read/13330 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.

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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.

]]> http://www.yourlawyer.com/articles/read/12937 Fri, 27 Jul 2007 00:00:00 -0700 http://www.yourlawyer.com/articles/read/12937 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.

]]> http://www.yourlawyer.com/articles/read/12921 Tue, 24 Jul 2007 00:00:00 -0700 http://www.yourlawyer.com/articles/read/12921 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.

]]> http://www.yourlawyer.com/topics/overview/pain_pump_shoulder_injury Tue, 24 Jul 2007 00:00:00 -0700 http://www.yourlawyer.com/topics/overview/pain_pump_shoulder_injury Pain Pump Shoulder Injury The use of intra-articular pain pumps in shoulder surgeries has been associated with a condition called Postarthroscopic Glenohumeral Chondrolysis (PAGCL).  PAGCL is the deterioration of cartilage in the shoulder following such procedures.   An intra-articular pain pump catheter is placed into the shoulder joint during these procedures.  The pain pump remains in the joint for several days to deliver pain medication to the shoulder.

PAGCL is one of the most common complications that can follow shoulder surgeries.  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 an extremely painful and life-altering condition.  Symptoms of PAGCL include pain at the should  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 this condition is further surgery; however, many patients never regain full use of their shoulder joint. 

Pain Pump Lawsuit Attorneys
The attorneys at Parker Waichman Alonso LLP have represented and filed lawsuits for hundreds of victims of defective medical devices and pain pump injuries with dignity and compassion.  If you or a loved one has suffered PAGCL as the result of an intra-articular pain pump or the pain paump later caused severe pain, loss of use of the shoulder or shoulder replacement, you may be entitled to compensation. Please fill out the form at the right for a free case review by a qualified pain pump lawsuit attorney.]]>