Imagine that you have torn your rotator cuff while playing softball. You set up an appointment with your doctor and he recommends a routine surgical procedure to repair your shoulder. You tell your doctor that you don’t want to use any pain killers, so he recommends a pain medicine pump instead.

Several months after the surgery you are still having problems with your shoulder. You have trouble with mobility and pain. You go in for a check-up, have some x-rays taken, and find out that your shoulder cartilage is deteriorating. Unfortunately, this is happening with greater frequency and has become the source of litigation across the united states. The condition is called Postarthroscopic Glenohumeral Chondrolysis (PAGCL for short), and it has been linked to certain pain medicine pumps that deliver medicine into the surgical site to help alleviate pain.

There has been a lot of good research done regarding shoulder surgery. One study worth noting is called, "Complications in Knee and Shoulder Surgery Management and Treatment Options for the Sports Medicine Orthopedist" by Robert J. Meislin and Jeffrey Halbrecht 10.1007/978-1-84882-203-015. Here is an excerpt: "Overall rate of complications after arthroscopic shoulder surgery was once believed to be quite low.1–3 For instance, Ellman reported no major complications, one localized hematoma at a portal site, and three transient dysesthesias in the thumb (attributed to inadequate padding on the traction device) in his review of 50 consecutive subacromial decompressions.4 Subsequently, a report from the Committee on Complications of the Arthroscopy Association of North America in the 1980s documented a wider range and scope of complications after arthroscopic shoulder surgery, and noted rates as low as 0.76% for subacromial space procedures and as high as 5.3% for arthroscopic anterior staple capsulorrhaphy.5 Even for the "experienced" surgeons, the committee noted a fairly high complication rate of 5.2% after arthroscopic shoulder surgery.6 More recent retrospective review studies noted even higher complication rates, between 6.5 and 10.5%, with adhesive capsulitis being the most common complication.7,8 In 2002, Weber and colleagues reviewed the available literature and found the overall complication rates after shoulder arthroscopy to be between 5.8 and 9.5%.9 Thus, complications after arthroscopic shoulder surgery may be more common than once believed and warrant particular attention to increase awareness and to provide appropriate treatment."

Another interesting study examines PAGCL and the relation to pain pumps. It is called, "Case Reports: Two Cases of Glenohumeral Chondrolysis after Intraarticular Pain Pumps" - Clinical Orthopaedics and Related Research Accepted: 14 January 2010 Published online: 29 January 2010. Here is an excerpt: "Abstract - Background Acute idiopathic chondrolysis in young adults is rare. The etiology often is unknown and outcomes can be devastating owing to rapid development of painful secondary osteoarthritis. There have been some recent reports of chondrolysis after arthroscopic shoulder procedures. Animal and laboratory data suggest chondrolysis is related to the use of intraarticular pain pumps, although there is no conclusive evidence that this is causative in patients. Case description - We present two cases of young adults with chondrolysis of the humeral head after intraarticular pain pump use with humeral head resurfacing and biologic glenoid resurfacing.

Literature review Several authors report glenohumeral chondrolysis after shoulder arthroscopy involving the use of bupivacaine pain pumps. In addition, experimental animal studies have confirmed the presence of chondrolysis after bupivacaine infusion.

Purposes and clinical relevance These cases provide additional evidence of an important association between postarthroscopic chondrolysis of the glenohumeral joint and the use of bupivacaine pain pumps."

If you found either of these reports interesting, please read them in their entirety. The more public awareness that is generated, the better. We all owe a great deal of gratitude to the people studying this condition.