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Studies show a strong association between the intra-articular (inside the joint space) use of high volume pain pumps following arthroscopic shoulder surgery and an otherwise unexplainable loss of hyaline cartilage in the shoulder joint. According to a study authored by Hansen, et al. and published in the American Journal of Sports Medicine, the complication, know as PAGCL, is permanent and can lead to extreme pain and lifelong suffering in 63% of the patients who receive continuous anesthetic via a post-operative pain pump.

What is PAGCL?

PAGCL is an acronym for:

Postarthroscopic (after arthroscopic surgery)

Glenohumeral (joint of glenoid fossa + humeral head)

Chondrolysis (breakdown of cartilage cells)

Symptoms of PAGCL

The symptoms of chondrolysis are experienced over a gradual period of time, with the intitial symptoms often occurring around three to four months after the pain pump’s administration. Symptoms include:

-Loss of shoulder cartilage
– Shoulder joint clicking, grinding, or popping
– Shoulder pain
– Shoulder weakness or stiffness
– Decreased range of movement
– Pain of moving at joint

Did the FDA Approve Pain Pumps for Intra-articular Use?

Continuous infusion pain pumps were not approved by the Food and Drug Administration for intra-articular use. Moreover, the manufacturers of these pumps have not published any clinical studies regarding the use of intra-articular administration of continuous infusion pain medicine. While widely used and promoted by the pump manufacturers, this form of anesthetic delivery is an off-label use and poses a serious risk to 63% of the patients on whom the device is used. In January 2009, Health Canada published a "Canadian Adverse Reaction Newsletter" urging surgeons to discontinue use of pain pumps regardless of manufacturer.

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