Monday, February 15, 2016

Chondrolysis in a young woman - how can this be managed? Part 2

In yesterday's post (link), we presented the case of a young woman with chondrolysis after arthroscopic surgery with the postoperative infusion of local anesthetics using pain pump.

This case reminded us of another young lady in her mid 20s from out of state.  Six years prior to our visit she sustained a left shoulder dislocation when she was hit while playing basketball while in high school. The shoulder was reduced at the game. A year later she  returned to basketball but dislocated her shoulder while bench pressing. She then had an arthroscopic shoulder repair in the summer of 2008 and had the postoperative infusion of local anesthetics using pain pump for the first 2 days afterwards. She developed painful stiffness over the next two years that was refractory to an arthroscopic release. She was referred to us for consideration of a ream and run procedure.

At the time of presentation she could perform only 4 of the 12 functions of the Simple Shoulder Test, had a very stiff shoulder that was painful on all movement and these x-rays showing the characteristic appearance of chondrolysis (see link).

Because of her high level of pain and severe stiffness we recommended a total shoulder, in spite of her young age. Although we gained full passive range of motion at surgery with vigorous releases, her shoulder became stiff after surgery. We manipulated her shoulder twice, once at two months and once at four months. 

Two years after surgery she was definitely improved over her preoperative status, but continued to have issues with stiffness and pain.

Her x-rays looked fine two years after surgery.

Three years after surgery she reported "I have been doing pretty well. Low pain and maintaining movement and muscle. The main issue I have been dealing with is handling the cold weather (or as "cold" as San Diego can get) and the achy feeling I get in my shoulder, which sometimes hinders my sleeping. I am continuously encouraged by almost every person in my life to stretch it every day. I typically have pain the day after I stretch it, which I am assuming is normal and more of an ache than actual pain." She indicates that she can now perform 10 of the 12 functions of the Simple Shoulder Test.

This case, like the one posted yesterday, show the devastating effect associated with pain pump use in young women after instability repairs as well as the difficulty in regaining comfort and function for the shoulders even after an optimal surgical reconstruction. It is apparent that the chondrolysis has an adverse effect not only on the cartilage, but also on the surrounding soft tissues.