Reactions 1324 - 23 Oct 2010

SBupivacaine

Chondrolysis following intra-articularadministration: 2 case reports

Two women developed glenohumeral chondrolysisduring treatment with intra-articular bupivacaine [dosagesnot stated; duration of treatments not clearly stated].

A 19-year-old female gymnast with right anteriorshoulder instability underwent surgical anterior capsularplication, and an intra-articular bupivacaine pain pump wasplaced before wound closure. Severe continuous pain andsubstantial shoulder stiffness persisted postoperatively. Onpresentation about 1 year after surgery, she exhibitedmarked pain with all shoulder motion and had been unableto resume gymnastics. Shoulder motion was restricted, andshe had a Penn shoulder score of 13/100. X-rays showedarthritic changes, and an MR arthrogram disclosed articularcartilage loss, and subchondral cysts in her humeral headand glenoid. On diagnostic arthroscopy, focal cartilagedefects were evident on her humeral head and glenoidsurface. She underwent surgical right hemicap humeralresurfacing implantation with graft jacket interposition ofthe glenoid. Only minimal pain at rest persisted on18-month follow-up, and examination revealed improvedmovement; her Penn shoulder score was 66/100, and sheresumed competitive gymnastics during her final year ofcollage.

A 26-year-old woman underwent surgical repair of a leftposterior glenoid labrum tear and. A bupivacaine painpump was placed for postoperative analgesia, but shedeveloped substantial stiffness and shoulder pain aftersurgery. Symptoms were initially attributed to adhesivecapsulitis, and arthroscopic debridement and capsularrelease were performed; the bupivacaine pain pump wasagain placed after surgery. Her symptoms persisted, andshe experienced continuous, severe shoulder pain at restand with movement. During her second arthroscopiccapsular release 12 months after the initial surgery,advanced chondrolysis of the articular surfaces of thehumeral head and glenoid were evident, and the procedurewas aborted. On presentation 1.5 years after the initialprocedure, shoulder movement was limited, and imagingstudies confirmed chondrolysis of the articular surfaces ofthe humeral head and glenoid. She underwent humeralhead resurfacing and interposition arthroplasty of theglenoid with a graft jacket. Pain at rest had resolved onfollow-up 16 months later, and passive forward flexion,abduction and neutral external rotation had improved. Shereturned to work, but continued to experience pain at thelimit of her motion and had difficulty reaching overshoulder height; she had a Penn shoulder score of 38/100.

Author comment: "Our cases add to the evidence of anassociation between pain pumps and glenohumeralchondrolysis."Anakwenze OA, et al. Case reports: two cases of glenohumeral chondrolysis afterintraarticular pain pumps. Clinical Orthopaedics and Related Research 468:2545-9, No. 9, Sep 2010 - USA 803042649

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Reactions 23 Oct 2010 No. 13240114-9954/10/1324-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved