Postarthroscopic glenohumeral chondrolysis is a rare complication that affects the glenohumeral joint that connects the shoulder socket to the ball of the bone on the upper arm. The condition causes the improper function of shoulder movement due to the deterioration of joint cartilage that results and severe complications in a variety of symptoms. Due to malfunction, the harm loses its capacity to move properly because the socket and bone start rubbing together, which destroys bone tissue.
Medical science has yet to determine how to effectively treat the complication nor cure the condition. The rapid deterioration of bone and cartilage tissue usually begins shortly after the patient has undergone arthroscopic surgery. Typically, postarthroscopic glenohumeral chondrolysis patients are young and range between 10 and 40 years of age. The condition is often diagnosed because of its unexplained, deep pain in the shoulder following surgery.
Doctors have made a direct correlation between the delivery of drugs through an intra-articular pain, and the development of chondrolysis after arthroscopic surgery. Many patients suffer a wide range of symptoms associated with the shoulder and its range of motion that usually develops within the first few months after arthroscopy procedures. However, some patients develop symptoms much later, up to one year after surgery. Many individuals who suffer from postarthroscopic glenohumeral chondrolysis never regain full mobility and use of the affected shoulder.
Prior to the development of postarthroscopic glenohumeral chondrolysis, every patient underwent a shoulder arthroscopic procedure where the shoulder joint was examined with a miniature camera and attached lighting through a small incision. During the procedure, the doctor might have possibly operated on the shoulder using minimally invasive surgical tools. However, many of the problems were exacerbated if the doctor chose to treat the pain using a disposable pain pump that delivered drugs into the shoulder socket, especially if the medication was administered to the affected area in high dosages.
The condition is progressive, meaning a can worsen significantly over time. The disorder is thought to be life altering because of the associated debilitation of the shoulder and the level of pain experienced by the patient. In addition, the loss of cartilage that was destroyed by the condition is irreversible because new cartilage will never form in the affected area. Usually, the only option for effective treatments to ensure optimal range of motion involves a complete shoulder replacement of the affected joint.
- Who Is at Risk for Postarthroscopic Glenohumeral Chondrolysis?
- Common Symptoms
- Diagnosing Postarthroscopic Glenohumeral Chondrolysis
- Treating the Condition
Who Is at Risk for Postarthroscopic Glenohumeral Chondrolysis?
Numerous risk factors and inherited patient factors are thought to correlate with postarthroscopic glenohumeral chondrolysis. However, it still remains unclear how these factors are directly associated. The most common risk factors associated with the condition include:
- Pain Pump Administered Bupivacaine – Medical identified a correlation between using a pain pump to administer a local anesthetic medication (bupivacaine) by Vivacaine, Marcain, Sensorcaine, and Marcaine and acute chondrolysis after infusion. While the correlation between chondrolysis and pain pumps administering local anesthetic has been identified as causing the condition in the glenohumeral shoulder joint, there is yet to be clinical proof of the same problem when treating knee disorders and repairs using pain pumps.
- Exposure to Radiofrequency or Thermal Conditions – Science has yet to determine the correlation of thermal and radio frequency and the development of chondrolysis, where the patient's developed postarthroscopic glenohumeral chondrolysis within 48 hours after the procedure.
Some studies show that these risk factors are significantly higher in younger females compared to males of the same age and older individuals of both genders. The National Institutes of Health discourages the use of pain pumps to deliver painkillers to the affected area following any arthroscopic shoulder surgery.
Other individuals most at risk of developing postarthroscopic glenohumeral chondrolysis after arthroscopic surgical procedures include those who have suffered prior trauma to the area, shoulder instability, or have had previous surgeries to the shoulder and those who have undergone surgery pain regimens.
Before undergoing the surgery, the doctor should obtain a comprehensive medical history to identify any potential underlying inflammatory arthropathy (joint inflammation abnormality), autoimmune condition, or college and disorder.
The most common symptoms associated with postarthroscopic glenohumeral chondrolysis following an arthroscopic surgical procedure include:
- Loss of shoulder mobility
- Rapidly progressing pain in the affected area
- Abnormal stiffness of the shoulder
- Decreasing range of motion that is secondary to shoulder discomfort and pain
- Pain that become significantly worse when the shoulder is in motion or at rest
- Radiograph identified narrowing of the shoulder's glenohumeral joint space
- Crepitus where the shoulder produces a grating sensation or clicking, popping, or grinding sound where cartilage and bone friction causes parts of the joint bones to fracture
- MRI (magnetic resonance imaging) scan that identifies marrow edema (swelling) and diffused bipolar articular cartilage loss
Many of the symptoms will develop within months after undergoing surgical procedures including shoulder arthroscopic procedures. The symptoms can be exacerbated if the patient is using a disposable pain pump to deliver pain medication directly into the shoulder socket. In addition, high dosages of pain drugs delivered by a pain pump can contribute to cartilage disintegration within the shoulder socket.
Diagnosing Postarthroscopic Glenohumeral Chondrolysis
Accurate diagnoses of postarthroscopic glenohumeral chondrolysis can be complicated because many of the signs and symptoms are associated with other pathologic conditions that cause damage to articular cartilage in the shoulder. However, the doctor will often recommend a variety of scan tests including CT (computed tomography) scans, MRI (magnetic resonance imaging), and traditional X-rays to provide a detailed image of the shoulders and bony structure.
Some of these images can provide useful information that identifies the loss of cartilage or lesions appearing on the cartilage that might be causing one or more of the symptoms. However, the findings can be inconclusive if advanced imaging does not provide definitive identification of chondral lesions.
Treating the Condition
The doctor typically has numerous options for treating postarthroscopic glenohumeral chondrolysis, based on the severity of the condition and other factors including patient preference. These options include:
- Nonsurgical Management – The doctor can manage the condition's associated function of mobility and pain. This includes physical therapy and/or an exercise program at home that emphasizes improving the range of motion while decreasing capsular (the ligament surrounding the articular cavity) tightness. These resistant and strengthening exercises can reduce the amount of joint irritation and help control the balance of the rotator cuff to avoid asymmetrical motion and minimize the forces on the glenohumeral joint.
- Surgery Involving Shoulder Arthroplasty or Debridement – If nonsurgical management is ineffective, the doctor can choose to perform surgery that might include total shoulder arthroplasty, hemiarthroplasty, or prosthetic articular resurfacing.
A debridement procedure is usually recommended for extensive chondral damage and/or damage to the rotator cuff, labrum, or biceps. Successful surgeries involve thoroughly irrigating the joint to remove loose debris and addressing bicep lesions while avoiding further damage to the areas muscles and tendons.
Typically, most damage caused by the condition is permanent unless the patient undergoes a complete shoulder replacement surgical procedure where an artificial replacement joint is installed. However, this procedure is not an option for every patient with the condition.