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Glenohumeral Chondrolysis Associated with Use of an Intra-Articular Pain Pump Delivering Local Anesthetics Following Manipulation Under AnesthesiaA Report of Four Cases
Juan A. Serrato, Jr., MD1; Cassie M. Fleckenstein, MS1; Samer S. Hasan, MD, PhD1
1 Cincinnati SportsMedicine Research and Education Foundation, 10663 Montgomery Road, 1st Floor, Cincinnati, OH 45242. E-mail address for C.M. Fleckenstein: cfleckenstein@csmref.org
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. One or more of the authors, or his/her institution, has received remuneration for expert testimony in pain pump litigation that did not relate to physician liability. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, Ohio

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Sep 07;93(17):e99 1-8. doi: 10.2106/JBJS.J.01604
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Extract

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.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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