Glenohumeral Chondrolysis Associated with Use of an Intra-Articular Pain Pump Delivering Local Anesthetics Following Manipulation Under Anesthesia

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Glenohumeral chondrolysis is a devastating condition characterized by rapid dissolution of the articular cartilage surfaces of the glenoid and the humeral head. Patients typically present with a painful stiff joint, and radiographs demonstrate joint space narrowing and subchondral cystic changes. Because most cases of glenohumeral chondrolysis have occurred following arthroscopic shoulder surgery, the term “post-arthroscopic glenohumeral chondrolysis” (PAGCL) has been used to describe this condition. Several causative factors have been implicated, including suture anchors that are prominent or that become loose1, excessive intra-articular use of thermal heat2-4, and intra-articular pain pump (IAPP) catheters delivering local anesthetics5-10. Most of the patients described developed glenohumeral chondrolysis following arthroscopic stabilization procedures in which one or more suture anchors were employed, with or without adjunctive use of thermal heat, and in which an IAPP was placed at the conclusion of the procedure to deliver local anesthetics for postoperative analgesia. To the best of our knowledge, glenohumeral chondrolysis developing after the use of an IAPP and without arthroscopy has not been described previously. We report four cases of glenohumeral chondrolysis that occurred following the use of an IAPP delivering either 0.25% or 0.5% bupivacaine with epinephrine for forty-eight to sixty hours after isolated manipulation of the shoulder under anesthesia, without a surgical procedure. In all four patients, the initial treatment, including manipulation and placement of an IAPP (AmbIT; Sorenson Medical Products, West Jordan, Utah), was done elsewhere by the same orthopaedic surgeon between March 2006 and August 2007. One of the four patients was treated with a subsequent prosthetic shoulder arthroplasty by another surgeon prior to referral to the senior author (S.S.H.). Each of the four patients in this series was informed that data concerning his or her case were submitted for publication, and verbal …