Beasley, Allen, Crow, Methvin, Portis & Miles, P.C.

The Food and Drug Administration (FDA) has released safety tips for nurses on elastomeric infusion devices, or pain pumps, used during and up to 72 hours after surgery to deliver a continuous amount of local anesthetic directly into the patient’s intra-articular space, or shoulder joint, for postoperative pain control. The FDA has received approximately 35 reports of chondrolysis in patients who received continuous intra-articular infusions with pain pump devices. This type of chondrolysis, called postarthroscopic glenhumeral chondrolysis (PAGCL), occurs when the shoulder cartilage is worn away, causing bone to rub against bone. It is a severe, life-altering complication that is usually irreversible. Many patients require a total shoulder replacement.

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Pain pumps are getting a bad rap lately, thanks to the emergence of chondrolysis, a debilitating condition that was once unheard of in the shoulder joint but is now affecting hundreds who have undergone shoulder surgery. But Pearland, Texas, Dr. Leo Lapuerta says the devices are not banned for all medical procedures and that they are particularly beneficial for plastic surgeries.

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Much has been reported lately about chondrolysis of the shoulder, or Postarthroscopic Glenohumeral Chondrolysis (PAGCL). So what is chondrolysis and why is it getting so much face time? Chondrolysis is the destruction of the cartilage in a joint. It is generally a rare condition anywhere in the body, but it has been most often heard of in hip joints most often from birth defects. Before the 1990s, chondrolysis in the shoulder was never seen.

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Patients who used pain pump devices to relieve pain from shoulder surgery are at risk for permanent joint damage, according to recent studies. Pain pumps are balloon-like devices that are filled with anesthetics that deliver medication directly into the surgical space via a catheter. The medication is slowly released into the joint space for up to 72 hours following surgery and then the catheter is removed by the patient.

While this use of pain pumps was a convenient way to relieve pain from surgery, it also resulted in a surprisingly high number of cases of a painful and debilitating deterioration of cartilage in the shoulder joint known as chondrolysis, specifically Postarthroscopic Glenhumeral Chondrolysis (PAGCL). The condition is permanent and many who suffer from it require shoulder replacement surgery.

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Gregg Zaun will have shoulder surgery next week, which will end the season early for the Milwaukee Brewers catcher. It may also mark the end of his career. “I’m not in a situation anymore where I need to play. I don’t need to play. I don’t need to play Major League Baseball to validate myself as a person,” Zaun said before the Brewers’ game against the Chicago Cubs. “Do I want to play? That’s a different story. It’s too uncertain to tell. I’m really upset about having surgery and my season being over.”

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Just as the baseball season was getting underway, Tampa Bay Rays J.P. Howell had surgery on his left shoulder, ending his season prematurely. The left-handed reliever had to stop a simulated game last week just after starting because of discomfort in his shoulder. Two days later he was in surgery. Howell is expected to be recovered enough to play in the 2011 season.

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Shoulder surgery may be the only hope for Chicago Cubs pitcher Angel Guzman to get back into the game. A recent MRI revealed that the right-handed pitcher had a severe tear in a ligament in his shoulder near his armpit. Despite the finding, he says he is seeking a second opinion from renowned orthopedic surgeon Dr. James Andrews to determine if surgery is preferable to a more conservative treatment. “It’s gong to be tough,” he told MLB.com. “By doing (the surgery), I have a small chance (of playing in the major leagues), but there is a chance.”

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Several local anesthetics have added warnings on their labels notifying health care professionals that using the drugs in intra-articular devices, or pain pumps, following arthroscopic and other surgical procedures is not approved and has been linked to cases of a painful and debilitating condition of the shoulder joint known as chondrolysis, according to the Food and Drug Administration (FDA) Drug Safety report for February 2010. The cases of chondrolysis were reported in both pediatric and adult patients following intra-articular infusions of the anesthetics with and without epinephrine, a hormone neurotransmitter, for 48 to 72 hours following surgery.

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Michael Johnson says neither he nor his doctor would have agreed to have a pain pump devices implanted into his shoulder joint during two arthroscopic surgeries if he knew that by doing so it would result in a full shoulder joint replacement. Johnson contends that the manufacturers of the medical device knew that the pain pumps were unreasonably and dangerously defective, and yet they did nothing to warn him or his surgeon about the risks associated with using it. Furthermore, he claims, the Food and Drug Administration (FDA) specifically prohibited the marketing of pain pump devices with anesthetics to be placed in the joint cavity.

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Patients who have had an orthopedic surgical procedure and received a prolonged infusion of a local anesthetic into the joint with a disposable elastomeric pump or any other infusion pump are urged by the Food and Drug Administration (FDA) to pay attention to symptoms of any joint pain, stiffness and decrease or loss of motion. If any of those symptoms persist, patients are advised to contact their health care professional.

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