Shoulder dislocations

A team of researchers and orthopaedic surgeons at Keller Army Hospital in West Point, New York, and the Uniformed Services University of the Health Sciences reviewed 8,940 shoulder dislocations in patients at 100 emergency rooms across the country between 2002 and 2006. Of all dislocations, 71.8 percent were in men; 46.8 percent were in patients between 15-29 years of age; and 48.3 percent occurred during sports or recreation activities. Of the injuries that occurred during sports-related injuries, 37 percent were specifically from football or basketball activities. Among women, those ages 80 to 90 were at greatest risk of shoulder dislocation, most often due to falls at home.

“We were not too surprised to find the high number of young males dislocating their shoulders during athletic activity,” wrote Brett Owens, MD, orthopaedic surgeon at Keller Army Hospital. “However, the rate of shoulder dislocations among elderly women was higher than we had previously assumed.”

Shoulder dislocation is a potentially painful and disabling condition, and treatment can vary depending on severity of symptoms. Most patients will improve with bracing and physical therapy, however some will require arthroscopic surgery.

SOURCE: Pain Pumps › Young men, elderly women at highest risk of shoulder dislocation

Jean-Thenistor Pascal

Pascal said he dislocated his right shoulder three times during the fight and had to have his shoulder popped back into place at least once by one of his cornermen. Despite having to box stretches almost entirely with his left hand, and looking hurt and worn down in the last few rounds, Pascal prevailed, earning a unanimous victory from the judges.

“I know I have a lot of guts,” Pascal said after the fight. “I knew it and now I really know it. When it happened the first time I told myself I was finished, but I couldn’t pull out in front of these fans. No way was I going to quit.”

Pascal’s surgery involved the removal of a bone chip and repair to the shoulder labrum, according to a statement released by promoter Groupe Yvon Michel. Pascal has been ordered to rest his shoulder for three weeks followed by five or six weeks of rehabilitation before he will be allowed to resume normal training. Pascal is scheduled to meet the WBC interim champion Chad Dawson in 120 days, but he may need to postpone that meeting until his shoulder recuperates.

Shoulder repair surgeries are about 85-95 percent successful. But some patients have had lingering problems, including the developing of a painful and debilitation condition known as chondrolysis. It wasn’t until after 2000 that doctors began to make a connection between a type of chondrolysis known as Postarthroscopic Glenohumeral Chondrolysis and the use of intra-articular pain pumps used in surgery. Details of that discovery were later published by The American Journal of Sports Medicine, and numerous lawsuits from those who suffer from chondrolysis have since filed suit against the makers of pain pumps.

Source: Montreal Gazette

SOURCE: Pain Pumps › WBC boxing champ undergoes shoulder repair surgery

Osteoarthritis is a common aliment that has earned the condition a top ranking in disability of Americans. Symptoms of stiffness, pain and limited movement are caused when the cartilage at the end of the bone breaks down, causing the bones to rub together at the joints. The most common remedy has been arthroscopic surgery, during which surgeons insert a scope with a camera through small incisions, where they smooth damaged cartilage surfaces and flush out bone chips. This allows for faster healing time than traditional surgery.

To alleviate pain following knee surgery, doctors at times will insert a pain pump to deliver medication directly to the surgical wound site. These post-operative pain pumps can help alleviate the pain associated with surgery, but they may come at a greater risk. Post-operative pain pumps, or intra-articular pain pumps, are routinely used in similar arthroscopic surgeries for shoulder injuries.

A recent study by The American Journal of Sports Medicine identified a link between the post-operative pain pumps and a painful, cartilage deteriorating condition known as Postarthoscopic Glenohumeral Chondrolysis, or PAGCL. PAGCL can cause irreversible damage and may require additional surgeries.

Patients who are considering knee surgery are advised to discuss alternative options with their physicians.

SOURCE: Pain Pumps › Studies show medication, physical therapy as effective as knee surgery

Shoulder arthroscopy is a rapidly expanding field because it offers a less invasive and less painful option for patients. In arthroscopy, two very small incisions are made, one for instruments and one for a miniature surgical camera to allow the surgeon’s viewing of the area without a large surgical site.

To manage post-surgical pain and extend the deployment of numbing agents, the use of temporary intra-articular shoulder pain pumps was introduced into these types of surgeries.

The procedure involves placing a flexible intra-articular shoulder pain pump catheter into the shoulder joint with the pump remaining in the joint for several days to deliver controlled doses of pain medication, often a combination of bupivacaine and epinephrine. This course of treatment became popular because it reduced recovery time without the need for narcotic pain relievers.

But a few days of relief can result in a debilitating and lifelong condition that causes severe-and often, permanent-pain and mobility loss and the need for constant medication. In some patients, complete loss of the use of the shoulder occurs.

PAGCL, one of the most common complications from shoulder surgeries is a condition where overwhelming damage to the shoulder occurs when cartilage deteriorates following these types of arthroscopic procedures. Without cartilage, there is no bone-to-bone cushion, causing bones to grind together and resulting in intense pain and, in some cases, chronic arthritis.

A study of 152 patients who underwent arthroscopic shoulder surgeries revealed that 12 of the patients developed PAGCL. All 12 PAGCL patients received pain pumps during their surgeries; the use of the pain pump was the only factor that the PAGCL patients had in common. In fact, studies suggest that up to 63% of arthroscopic shoulder surgery patients who received an intra-articular pain pump are at risk for developing PAGCL.

In addition to living with acute pain and daily medication, PAGCL may result in a need for follow-up surgery. Unfortunately, arthroscopic surgery is not an option. The damage that occurs with PAGCL requires the more painful and invasive shoulder joint replacement surgery (arthroplasty), a more intense surgery option over arthroscopy. Arthroplasty involves replacing the joint with plastic and metal components. Surgery lasts two and three hours and patients usually remain in the hospital for three nights. Physical therapy is almost always required following this type of procedure. Despite surgery, many patients never fully regain use of their joint and some patients report increased pain.

No consistently successful PAGCL treatment has emerged and the damage from PAGCL is believed to be irreversible. Unfortunately, pain medications seem to worsen the symptoms of PAGCL and offer no long-term value concerning treatment or cure.

PAGCL tends to develop two to twelve months following surgery. Symptoms include shoulder pain, whether in motion or at rest; increased shoulder stiffness; popping or grinding when the shoulder is in motion; decreased to full loss of range of motion; and loss of joint strength. Diagnosis of PAGCL is confirmed via an x-ray indicating narrowing of the shoulder joint space and indicating additional surgery is required to replace the destroyed joint.

November 15th, 2007

SOURCE: Pain Pumps › Shoulder pain pumps can result in lifetime disability