| There is pending litigation across the country involving | | | | between January 1960 and April 2009. After we |
| shoulder pain pumps that release medication for | | | | applied inclusion and exclusion criteria, 35 articles were |
| pain. Plaintiffs are asserting that the medication used | | | | stratified into 4 categories of factors related to |
| in these pumps causes a condition known as | | | | PAGCL: (1) patient factors, (2) surgical factors |
| Postarthroscopic Glenohumeral Chondrolysis (or | | | | (preoperative and intraoperative), (3) postoperative |
| cartilage loss). | | | | factors, and (4) causal pathways. |
| PAGCL is characterized by a degeneration of the | | | | Conclusions |
| cartilage in the shoulder joint, causing a substantial | | | | The literature is limited to correlates, rather than true |
| reduction in the shoulder's range of motions. PAGCL | | | | risk factors, for PAGCL. Well-designed epidemiologic |
| patients experience severe pain or tenderness in the | | | | studies that examine various exposures in relation to |
| shoulder area, shoulder stiffness or weakness, or a | | | | health outcomes, while controlling for potential |
| grinding or popping sensation in the shoulder joint. | | | | confounders, are needed to determine relative risks |
| PAGCL is permanent. There is no known cure or | | | | that allow causal inference, thereby facilitating sound |
| effective treatment. Some patients may be able to | | | | practice and policy decision making." |
| control their pain and other symptoms with pain killers | | | | Another interesting body of research can be found in |
| and anti-inflammatory medicine. However, if pain | | | | "Postarthroscopic Chondrolysis of the Glenohumeral |
| medication is not sufficient to help a PAGCL sufferer, | | | | Joint" by J. Rey II, J. Reineck, S. Krishnan, W. |
| a replacement of the entire shoulder joint may be | | | | Burkhead Jr. - |
| necessary. | | | | Seminars in Arthroplasty, Volume 20, Issue 2, Pages |
| There has been some fantastic research done on | | | | 98-103. Here is an excerpt: |
| regarding PAGCL. One study is called, | | | | "Abstract - Chondrolysis is a process of unknown |
| "Glenohumeral Chondrolysis After Arthroscopy: A | | | | etiology characterized by rapid progressive cartilage |
| Systematic Review of Potential Contributors and | | | | destruction with resultant pain and loss of motion. |
| Causal Pathways" by D. Solomon, M. Navaie, E. | | | | Chondrolysis after arthroscopic surgery of the |
| Stedje-Larsen, J. Smith, M. Provencher - Arthroscopy: | | | | shoulder is multifactorial. Recent reports suggest that |
| The Journal of Arthroscopic & Related Surgery, | | | | the heat from radiofrequency ablation devices, |
| Volume 25, Issue 11, Pages 1329-1342. Here is an | | | | certain bioabsorbable implants, and the local |
| excerpt: | | | | anesthetics delivered in excessive doses via pain |
| "Abstract – Purpose - This systematic review | | | | pumps could play a role in its development. We |
| provides (1) a synthesis of existing clinical evidence | | | | review the current understanding of this condition |
| that helps identify factors associated with the | | | | and our institution's experience with glenohumeral |
| development of glenohumeral chondrolysis after | | | | chondrolysis. Our discussion will serve almost |
| arthroscopy (PAGCL), (2) a consolidated | | | | exclusively as a caveat to surgeons of a potentially |
| conceptualization of potential causal pathways that | | | | catastrophic complication in the young patient." |
| elucidate proposed mechanisms leading to PAGCL, | | | | We all owe a great deal of gratitude to the people |
| and (3) a summary of implications for practice, policy, | | | | studying PAGCL, and should do our best to raise |
| and future research. | | | | public awareness. If you found either of these |
| Methods | | | | excerpts interesting, please read the studies in their |
| A computerized literature review using an iterative | | | | entirety. |
| search process identified 245 publications in English | | | | |