Shoulder arthroscopy can relieve pain and improve range of motion in the shoulder, but it is not without risks. Postarthroscopic Glenohumeral Chondrolysis (PAGCL) is a devastating complication of this procedure where the cartilage in the shoulder begins to deteriorate months after surgery, causing pain, stiffness, and sometimes the inability to use the affected shoulder.
Arthroscopic surgery involves the use of a tiny camera. Instead of making a large incision, two very small incisions are made, one for the camera and the second for any needed surgical instruments. The surgeon views the images on monitor. When all goes well, shoulder arthroscopy can be used for diagnostics and repair, with minimal trauma, reduced pain, and shortened recovery time.
Even so, shoulder arthroscopy can be an extensive procedure requiring a significant amount of pain medication. After surgery, oral pain killers, such as hydrocodone or morphine, and anti-inflammatory medications are administered. Additionally, a disposable pain pump is often used. The pump typically contains Marcaine (Bupivacaine) or Xylocaine (Lidocaine) and may contain Epinephrine which is pumped directly into the shoulder joint through a catheter. The pain pump is used for two or three days and the catheter can be removed by the patient when the pump is no longer needed.
The use of the pain pump after shoulder arthroscopy has been closely tied to PAGCL, possibly because of the high concentration of the pain medication pumped directly into the surgery site.
The glenohumeral joint is composed of the ball at the end of the arm bone and the socket of the shoulder blade, joining the arm and shoulder. The head of the arm bone is covered in articular cartilage, allowing the shoulder joint to move smoothly and preventing grinding and pain.
Chondrolysis translates to cartilage cutting apart. Glenohumeral chondrolysis is the breakdown and/or dissolution of the cartilage in the shoulder joint. Without this cartilage the shoulder cannot move smoothly and properly. The result is pain, stiffness and reduced range of motion. Symptoms of PAGCL include:
- Shoulder stiffness
- Pain when the shoulder is in motion
- Pain when the shoulder is at rest
- Clicking, popping, and/or grinding
- Shoulder weakness
- Decreased range of motion
- Narrowing joint space, visible on x-ray
These symptoms are usually not seen until months after surgery.
When PAGCL results in severe cartilage loss, shoulder replacement surgery is necessary to treat the condition.