Rapid Response

About PAGCL

An October 2007 article in the American Journal of Sports Medicine reported a link between intra-articular pain pumps following arthroscopic shoulder surgery and an extremely painful, debilitating condition known as Postarthroscopic Glenohumeral Chondrolysis (PAGCL).

The disposable pain pumps, which are implanted in the intra-articular (inside the joint) space during the procedure, are often used for two or three days to deliver high doses of pain medication. The most common combination of pain medications delivered through the pump is bupivacaine with epinephrine. Surgeons have preferred the pumps for pain management because the flexible plastic catheters deliver the medications directly to the shoulder joint and also boost the effectiveness of oral painkillers for up to 48 hours.

However, the American Journal of Sports Medicine article reported that use of the high-volume pain pumps following arthroscopic surgery resulted in an otherwise unexplainable loss of hyaline cartilage in the shoulder joint -- Postarthroscopic Glenohumeral Chondrolysis (PAGCL). The study stated that PAGCL caused extreme pain and lifelong suffering in 63 percent of the patients that use the pain pumps.

PAGCL affects athletes as young as 18 as well as elderly people who have compromised health. Symptoms of PAGCL include:

• Pain at the shoulder, whether at rest or in motion
• Increased shoulder stiffness
• Popping or grinding when the shoulder is in motion
• Decreased range of motion
• Loss of strength in the joint

Research presented at a 2006 meeting of the American Academy of Orthopedic Surgeons also showed evidence that use of pain pumps lead to PAGCL. The complication is usually diagnosed with an x-ray showing the narrowing of the shoulder joint space – which occurs as the shoulder’s glen humeral joint – the joint at the end of the shoulder, where the shoulder and arm meet -- begins to deteriorate after surgery. As the cushioning cartilage begins to deteriorate, the individual starts to experience the extremely pain associated with PAGCL.

The only treatment for PAGCL is more a more painful, open procedure, known as arthroplasty. This procedure uses artificial parts made of plastic and metal to replace the damaged joint. It is serious surgery that requires general anesthesia and significant recovery time.

Anyone experiencing symptoms associated with PAGCL following the implantation of a pain pump should seek medical attention immediately. There are currently several lawsuits pending against the manufacturers of the most popular pain pumps, including Stryker, DJO Inc., I-Flow Inc. and BREG Inc. The lawsuits allege that the defendants did not warn the medical community that the safety of the pumps had not been fully established.

In response to study results linking shoulder pain pumps to PAGCL, I-Flow issued this warning about its ON-Q DFU (a shoulder pain pump): “Avoid placing the catheter in joint spaces. Although there is no definitive established causal relationship, some literature has shown a possible association between continuous intra-articular infusions (particularly with bupivacaine) and the subsequent development of chondrolysis.”

If you or a loved one has experienced cartilage damage and pain due to Postarthroscopic Glenohumeral Chondrolysis (PAGCL) following shoulder arthroscopic surgery, contact our law offices immediately. You may be entitled to compensation.