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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May 18th, 2009 at 6:06 am
I am a 52 year old male, I have a a surgery scheduled on 5/21/09 (shoulder).After reading this article i am perhaps rethinking the method of Pain meds to be used. This type of pain controlled was mentioned. THANK YOU,Jim
June 2nd, 2009 at 9:10 pm
I’m 22,had surgery at 18. I was sent home with a pain pump.. I now suffer from snapping scapula syndrome, it hurts to carry my 2 year old child around and I have noticable weakness and muscle loss.. It’s about time I get some help.
November 4th, 2009 at 9:49 am
I am a 30 year old female with shoulder surgery scheduled mid December 2009. I will be asking for an alternative to the pain pump following the procedure thanks to these recent findings. I feel awful for those who are suffering because of this, as if it was not enough to suffer so long prior to the surgery itself. My heart goes out to you.
December 24th, 2009 at 6:39 pm
I have been in pain for over a year I know I have pagcl but ever time I ask the doctors in the small town of panama city they seem to change the subject about it.I have had mri,xrays and gone to a neurologist only do I hurt every day I now have nerve damage in my right are after the surgery and they say there’s no way to tell if it was done during the surgery which I’m not buying