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Doctors concerned about rise of PAGCL cases
Postarthroscopic Glenohumeral Chondrolysis (PAGCL) is a serious, debilitating condition that occurs after arthroscopic surgery. Arthroscopic surgery, a minimally invasive surgical procedure, is oftentimes used to diagnose problems present in the knee, spine, and wrist. Several reports published in a wide array of scientific and medical journals have raised questions about the many possible complications associated with arthroscopic surgery within the shoulder joint. They have suggested that the possibility of post-surgical problems, especially with a recent spike in cases of PAGCL, might outweigh the potential positive effects of the surgery.
The glenohumeral joint, commonly known as the shoulder joint, is a ball and socket joint which contains a large amount of cartilage, major ligaments that move the arm, and the tendon connector for the bicep. In cases of PAGCL, the cartilage between the humerus(the bone from the elbow to the shoulder) and the scapula(shoulder blade) has severely deteriorated, to the point where the bones grind into each other, creating intense pain. Additional symptoms of PAGCL include pain at the shoulder when it is in motion or at rest; increased shoulder stiffness; popping or grinding when the shoulder is in motion; decrease in range of motion; and a loss of strength in the joint.
PAGCL is identified via x-ray and, in many of these cases, traditional treatment through activity modifications, anti-inflammatory medications, and physical therapy all fail to produce positive results. For those patients who fail to respond to these traditional remedies, additional surgery is suggested usually an arthroplasty. With an arthroplasty, a surgeon takes a dysfunctional joint surface and either replaces it with something better, remodels, or realigns the joint. Typically, the surgeon grinds down the head of the joint and replaces it with either a metal or composite substance of metal and high density plastic. However, surgery does not always provide complete relief from PAGCL pain. Patients can end up with more shoulder pain than they experienced prior to their initial surgery, with the possibility of chronic shoulder pain.
The recent rise in cases of PAGCL has been a cause for concern in the medical community. At the American Academy of Orthopaedic Surgeons 2006 Annual Meeting, M.W. Larsen, MD, and coworkers presented a paper entitled "Severe Glenohumeral Chondrolysis Following Shoulder Arthroscopy Resulting in Arthroplasty," in which he explained that the rise of cases of severe PAGCL can occur after shoulder arthroscopy and may be associated with use of thermal devices. However, some patients developed chondrolysis after minimal or no use of the thermal devices. The use of thermal devices is not the only potential cause of PAGCL pain. Additional studies have suggested that the use of a device known as a pain pump could also be directly responsible for the development of PAGCL in patients. B. Hansen and associates presented a paper entitled "Post-arthroscopic Shoulder Chondrolysis With Associated Intra-articular Pain Pump Catheter Use," where it was posited that the use of these pain pump catheters dramatically increased the possibility of PAGCL. The study examined 152 patients who had received anthroscopic shoulder surgeries; twelve of the patients developed PAGCL. The common linkage between all of the patients who developed PAGCL was that all had received pain pumps during their surgeries.
PAGCL Causes
The glenohumeral joint, commonly known as the shoulder joint, is a ball and socket joint which contains a large amount of cartilage, major ligaments that move the arm, and the tendon connector for the bicep. In cases of PAGCL, the cartilage between the humerus(the bone from the elbow to the shoulder) and the scapula(shoulder blade) has severely deteriorated, to the point where the bones grind into each other, creating intense pain. Additional symptoms of PAGCL include pain at the shoulder when it is in motion or at rest; increased shoulder stiffness; popping or grinding when the shoulder is in motion; decrease in range of motion; and a loss of strength in the joint.
PAGCL Treatments
PAGCL is identified via x-ray and, in many of these cases, traditional treatment through activity modifications, anti-inflammatory medications, and physical therapy all fail to produce positive results. For those patients who fail to respond to these traditional remedies, additional surgery is suggested usually an arthroplasty. With an arthroplasty, a surgeon takes a dysfunctional joint surface and either replaces it with something better, remodels, or realigns the joint. Typically, the surgeon grinds down the head of the joint and replaces it with either a metal or composite substance of metal and high density plastic. However, surgery does not always provide complete relief from PAGCL pain. Patients can end up with more shoulder pain than they experienced prior to their initial surgery, with the possibility of chronic shoulder pain.
PAGCL Cases on the Rise
The recent rise in cases of PAGCL has been a cause for concern in the medical community. At the American Academy of Orthopaedic Surgeons 2006 Annual Meeting, M.W. Larsen, MD, and coworkers presented a paper entitled "Severe Glenohumeral Chondrolysis Following Shoulder Arthroscopy Resulting in Arthroplasty," in which he explained that the rise of cases of severe PAGCL can occur after shoulder arthroscopy and may be associated with use of thermal devices. However, some patients developed chondrolysis after minimal or no use of the thermal devices. The use of thermal devices is not the only potential cause of PAGCL pain. Additional studies have suggested that the use of a device known as a pain pump could also be directly responsible for the development of PAGCL in patients. B. Hansen and associates presented a paper entitled "Post-arthroscopic Shoulder Chondrolysis With Associated Intra-articular Pain Pump Catheter Use," where it was posited that the use of these pain pump catheters dramatically increased the possibility of PAGCL. The study examined 152 patients who had received anthroscopic shoulder surgeries; twelve of the patients developed PAGCL. The common linkage between all of the patients who developed PAGCL was that all had received pain pumps during their surgeries.
