PAGCL – Man-Made or Man Induced?
August 24th, 2009. By LucyC
Post arthroscopic glenohumeral chondrolysis (PAGCL)—ever heard of it? Chances are probably not—unless you have it.
PAGCL is a painful and debilitating condition characterized by the deterioration of cartilage between bones—cartilage is the stuff that prevents bone from grinding on bone. The problem with cartilage is that it doesn’t renew itself when it becomes damaged. There’s no blood flow to cartilage—so it can’t renew itself. So, once damaged, forever damaged.
It turns out that some types of pain medication delivered via a shoulder pain pump for example, are toxic to cartilage, and can cause PAGCL. So the very thing that’s meant to help in fact harms, permanently. Some reports suggest that just a few days worth of exposure can harm the cartilage.
The pain pump comes in because this is how the medications are administered directly to the shoulder joint. Pain pumps are used after surgery to deliver pain medication directly to the knee or shoulder joint, and they are a relatively recent medical device. Over the past few years the shoulder pain pump has undergone some changes—specifically the site of delivery of the medication—it now delivered medication directly into the joint—i.e. around the cartilage—and not the soft tissue surrounding the joint.
In a study published in the American Journal of Sports Medicine (2007), researchers found a correlation between PAGCL and intra-articular pain pump catheters. They looked at data on 177 people who underwent arthroscopy of the shoulder within a certain time frame, and found that only 19 people had had intra-articular pain pump catheters filled with bupivacaine and epinephrine. The authors wrote “Of these, 12 have been identified with chondrolysis.”
They concluded, “Use of intra-articular pain pump catheters eluting bupivacaine with epinephrine appear highly associated with postarthroscopic glenohumeral chondrolysis.”
And they further commented that “Intra-articular pain pump catheters, especially those eluting bupivacaine with epinephrine, should be avoided until further investigation.”
So it would appear that while PAGCL is not a man-made condition, it may be induced through human action—specifically implanting of a shoulder pain pump. And that’s where the lawyers come in.
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