A Shoulder Pain Pump "What-If" Played Out for Real

Seattle, WAIt's almost impossible for a shoulder pain pump patient to experience a "what-if" in practice. In other words, "what if I didn't have a shoulder pain pump inserted following my shoulder surgery? Would I have the pain, the lack of mobility, the frustration that the pain pump allegedly caused—had I not had the pump?"

That "what-if" played out in practice for a 37-year-old canine officer. As chronicled in UW Medicine, a publication of the University of Washington School of Medicine, the young woman injured both of her shoulders in a fall. Following shoulder surgery on both shoulders, the patient was outfitted with shoulder pain pumps in each shoulder, feeding pain medication directly to the shoulder joint.

However, only the pain pump servicing the left shoulder functioned properly. The pump hooked into the woman's right shoulder leaked pain medication outside the shoulder. Little, if any, pain medication made it to the joint in her right shoulder.

It may have saved her shoulder.

According to UW Medicine, the woman required two additional surgeries on her left shoulder only. During the second shoulder pain surgery, doctors were alarmed to discover that the articular cartilage in her left shoulder was nearly gone. Her right shoulder was in much better shape—a fact demonstrated by range of motion tests conducted by her doctors at the university.

"On physical examination, her right shoulder had 140 degrees of forward elevation, 60 degrees of external rotation, and internal rotation to T12," stated a summary of the patient's testing. "Her left shoulder was extremely stiff with only a 30-degree arc of rotation and flexion/extension. Radiographs showed significant left glenohumeral joint space narrowing."

The doctors reported concerns that chondrolysis was suspected on the patient's left shoulder following the [successful] use of the shoulder pain pump. Doctors were also concerned with regard to the need for arthroplasty (shoulder replacement) in such a "young, active patient," coupled with the doctor's capacity to return the patient to a "very active profession.

"It is interesting to note," concluded the medical team treating and consulting the patient, "that nearly identical procedures were performed on each shoulder and that chondrolysis only developed on the side that had a functioning postoperative pain catheter placed."

Pain pumps were originally approved by the US Food and Drug Administration (FDA) for delivery of pain medication to the soft tissue surrounding the shoulder, but never directly to the shoulder joint itself. Doctors have reported that manufacturers of shoulder pain pumps failed to inform doctors of this, and allegedly encouraged doctors to use the pain pumps off-label in such fashion. Shoulder repair surgery has often followed use of a shoulder pain pump directly to the shoulder joint.