There is pending litigation across the country involving shoulder pain pumps that release medication for pain. Plaintiffs are asserting that the medication used in these pumps causes a condition known as Postarthroscopic Glenohumeral Chondrolysis (or cartilage loss).

PAGCL is characterized by a degeneration of the cartilage in the shoulder joint, causing a substantial reduction in the shoulder’s range of motions. PAGCL patients experience severe pain or tenderness in the shoulder area, shoulder stiffness or weakness, or a grinding or popping sensation in the shoulder joint.

PAGCL is permanent. There is no known cure or effective treatment. Some patients may be able to control their pain and other symptoms with pain killers and anti-inflammatory medicine. However, if pain medication is not sufficient to help a PAGCL sufferer, a replacement of the entire shoulder joint may be necessary.

There has been some fantastic research done on regarding PAGCL. One study is called,

"Glenohumeral Chondrolysis After Arthroscopy: A Systematic Review of Potential Contributors and Causal Pathways" by D. Solomon, M. Navaie, E. Stedje-Larsen, J. Smith, M. Provencher - Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 25, Issue 11, Pages 1329-1342. Here is an excerpt:

"Abstract – Purpose - This systematic review provides (1) a synthesis of existing clinical evidence that helps identify factors associated with the development of glenohumeral chondrolysis after arthroscopy (PAGCL), (2) a consolidated conceptualization of potential causal pathways that elucidate proposed mechanisms leading to PAGCL, and (3) a summary of implications for practice, policy, and future research.

Methods

A computerized literature review using an iterative search process identified 245 publications in English between January 1960 and April 2009. After we applied inclusion and exclusion criteria, 35 articles were stratified into 4 categories of factors related to PAGCL: (1) patient factors, (2) surgical factors (preoperative and intraoperative), (3) postoperative factors, and (4) causal pathways.

Conclusions

The literature is limited to correlates, rather than true risk factors, for PAGCL. Well-designed epidemiologic studies that examine various exposures in relation to health outcomes, while controlling for potential confounders, are needed to determine relative risks that allow causal inference, thereby facilitating sound practice and policy decision making."

Another interesting body of research can be found in "Postarthroscopic Chondrolysis of the Glenohumeral Joint" by J. Rey II, J. Reineck, S. Krishnan, W. Burkhead Jr. -

Seminars in Arthroplasty, Volume 20, Issue 2, Pages 98-103. Here is an excerpt:

"Abstract - Chondrolysis is a process of unknown etiology characterized by rapid progressive cartilage destruction with resultant pain and loss of motion. Chondrolysis after arthroscopic surgery of the shoulder is multifactorial. Recent reports suggest that the heat from radiofrequency ablation devices, certain bioabsorbable implants, and the local anesthetics delivered in excessive doses via pain pumps could play a role in its development. We review the current understanding of this condition and our institution's experience with glenohumeral chondrolysis. Our discussion will serve almost exclusively as a caveat to surgeons of a potentially catastrophic complication in the young patient."

We all owe a great deal of gratitude to the people studying PAGCL, and should do our best to raise public awareness. If you found either of these excerpts interesting, please read the studies in their entirety.