Shoulder pain management pumps used following arthroscopic shoulder surgery have been linked to the development of a rare condition which causes the progressive destruction of cartilage in the shoulder joint. This painful and debilitating condition has no consistently successful treatment and often results in permanent shoulder pain.

The devastating condition, known as Post-Arthroscopic Glenohumeral Chondrolysis (PAGCL), typically manifests 3 to 12 months after shoulder surgery.

Symptoms which could develop following arthroscopic shoulder surgery include:

• Shoulder pain whether in motion or at rest;
• Clicking, popping or grinding of the shoulder;
• Shoulder stiffness or weakness;
• Decreased range of motion.

Postarthroscopic Glenohumeral Chondrolysis

Brent P. Hansen, DO,*, Charles L. Beck, MD, Elizabeth P. Beck, RN and Robert W. Townsley, PA-C
From  Advanced Joint Care and Orthopedic Sports Medicine, Glendale, Arizona, and  Center of Orthopedic and Rehabilitation Excellence, West Jordan, Utah

Background: Recent reports have noted the appearance of postarthroscopic glenohumeral chondrolysis. Although this devastating process has been identified, no cause has been directly identified.

Hypothesis: A cause of postarthroscopic glenohumeral chondrolysis will be associated with a specific factor (ie, implanted device, surgical technique, etc), and this factor can be identified by a review and comparison of cases seen in the senior author’s office.

Study Design: Case series; Level of evidence, 4.

Methods: Analyze possible etiologic factors with imaging studies, demographics, history, and physical examinations of 10 patients (12 shoulders) with postarthroscopic glenohumeral chondrolysis, and then compare perisurgical information with a focused chart review and comparison with the rest of the 177 arthroscopic shoulder surgeries in the same period of time.

Results: There were 12 cases of postarthroscopic glenohumeral chondrolysis (all were the senior author’s patients). Four common factors were identified, and only high-flow intra-articular pain pump catheters filled with bupivacaine and epinephrine were a new addition to years of shoulder surgery by the senior author; 177 shoulders underwent arthroscopy in the identified time frame, and only 19 shoulders, of 30 with capsular procedures, had intra-articular pain pump catheters filled with bupivacaine and epinephrine. Of these, 12 have been identified with chondrolysis.

Conclusion: Use of intra-articular pain pump catheters eluting bupivacaine with epinephrine appear highly associated with postarthroscopic glenohumeral chondrolysis.

Clinical Relevance: Intra-articular pain pump catheters, especially those eluting bupivacaine with epinephrine, should be avoided until further investigation.

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