Chondrolysis

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EditedFrederick A. Matsen III, M.D. By , Professor, UW Orthopaedics & Sports Medicine

Last updated: July 1, 2013

Contact
If you have questions regarding the ream and run procedure, feel free to email Frederick A. Matsen III M.D. at matsen@uw.edu.

For a recent publications on the factors causing chondrolysis, see Risk Factors for Chondrolysis of the Glenohumeral Joint and Published evidence demonstrating the causation of glenohumeral chondrolysis by postoperative infusion of local anesthetic via a pain pump.

For additional information on chondrolysis and its management, see the Shoulder Arthritis Blog.

Overview

Chondrolysis of the shoulder after arthroscopy - association with pain pumps to infuse local anesthetics after shoulder arthroscopy. Chondrolysis is a severe type of shoulder arthritis in which the cartilage of the joint is abruptly lost. It can occur in otherwise healthy shoulders after arthroscopic procedures. The risk of chondrolysis is increased when local anesthetics - either Bupivacaine (Marcaine) or Lidocaine (Xylocaine) - are infused into the joint for postoperative pain control. The inclusion of epinephrine in the infusion may further increase the risk. The risk of chondrolysis is also increased when radiofrequency or thermal energy are used in the joint.

Treatment of shoulder chondrolysis may require a ream and run procedure or a total shoulder.

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Treatment of shoulder chondrolysis

Treatment of shoulder chondrolysis

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Glenoid with chondrolysis

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Humeral head with chondrolysis

At the University of Washington Shoulder and Elbow Service we are seeing increasing numbers of patients referred with chondrolysis of the shoulder (glenohumeral joint). To date each of these cases has been associated with shoulder arthroscopy and the post-arthroscopic infusion of local anesthetics. The X-ray appearance and the surgical pathology consistently demonstrate the complete loss of articular cartilage not the focal loss that might be associated with mechanical damage from for example suture anchors. In none of these cases did infection or the use of intra-articular radiofrequency energy appear to be associated factors. Below are a series of radiographs and surgical photographs from these patients presented to demonstrate the characteristic features of this condition. Each of the patients was between 21 and 45 years of age and each had an arthroscopic procedure to address instability or a SLAP tear.

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Radiographs / X-rays

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Anteroposterior View

Anteroposterior View

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Anteroposterior View

Anteroposterior View

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Anteroposterior View

Anteroposterior View

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Anteroposterior View

Anteroposterior View

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Anteroposterior View

Anteroposterior View

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Anteroposterior View

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Anteroposterior View

Anteroposterior View

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Axillary View

Axillary View

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Axillary View

Axillary View

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Axillary View

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Axillary View

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Axillary View

Axillary View

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Axillary View

Axillary View

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Axillary View

Surgical Photos

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Humeral Head

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Humeral Head

Humeral Head

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Humeral Head

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Humeral Head

Humeral Head

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Glenoid

Glenoid

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Glenoid

Glenoid

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Glenoid

Glenoid

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Glenoid

Glenoid

Shoulder & Elbow Articles

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  2. Anterior glenoid reconstruction for unstable dislocating shoulders. Surgery to restore lost anterior glenoid bone and deep the socket with a bone graft can restore shoulder anatomy and lessen pain and improve function.
  3. Arthroplasty in Cuff Tear Arthropathy: Surgery for shoulders with a rotator cuff tear and arthritis can lessen shoulder pain and improve function with joint replacement.
  4. Atraumatic Shoulder Instability.
  5. Bankart repair for unstable dislocating shoulders: Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals.
  6. Basics of failed shoulder surgery, complications of shoulder surgery and revision shoulder surgery
  7. Chondrolysis
  8. Clinical Presentation and Evaluation of Glenohumeral Arthritis.
  9. Clinical Presentation of Glenohumeral Instability.
  10. Compartmental Syndromes.
  11. Diagnosis of Capsulorraphy Arthropathy.
  12. Diagnosis of the Frozen Shoulder.
  13. Evaluation of Recurrent Instability.
  14. Evaluation of the Rough Shoulder.
  15. Evaluation of the Stiff Shoulder.
  16. Evaluation of the Weak Shoulder.
  17. Examination Under Anesthesia.
  18. Failed Shoulder Replacement and Revision.
  19. Glenohumeral Arthritis References.
  20. Home Exercises for the Rough Shoulder.
  21. Home Exercises for Stiff Shoulder
  22. Home Exercises for the Unstable Shoulder.
  23. Home Exercises for the Weak Shoulder.
  24. Humeroscapular Positions and Motion.
  25. Humerothoracic Positions and Motion.
  26. Injuries Associated with Anterior Dislocations.
  27. Intermediate Shoulder Instability.
  28. Management of Glenohumeral Arthritis.
  29. Mechanics of Glenohumeral Arthritis.
  30. Mechanics of Glenohumeral Arthroplasty.
  31. Mechanics of Glenohumeral Instability.
  32. Mechanics of Shoulder Strength.
  33. More Information on Rotator Cuff Surgery.
  34. Posterior glenoid osteoplasty for unstable dislocating shoulders. Surgery to build up the back of the glenoid socket using an osteotomy and graft can restore shoulder anatomy and lessen pain and improve function.
  35. Ream and Run for Shoulder Arthritis: Conservative Reconstructive Surgery for Selected Individuals Desiring Higher Levels of Activity than Recommended for Traditional Total Shoulder Joint Replacement
  36. Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.
  37. Rehabilitation after Shoulder Arthroplasty.
  38. Rehabilitation following shoulder joint replacement arthroplasty
  39. Relevant Anatomy of Glenohumeral Instability.
  40. Repair of Rotator Cuff Tears: Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty.
  41. Reverse Shoulder Replacement (Delta joint replacement) for arthritis: Surgery with a reverse prosthesis can lessen shoulder pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability.
  42. Reverse Total Shoulder or Delta Shoulder for Shoulder Arthritis Combined with Massive Rotator Cuff Tear and for Failed Conventional Total Shoulder Replacement
  43. Rotator Cuff Clinical Presentation.
  44. Rotator Cuff Differential Diagnosis.
  45. Rotator Cuff Failure.
  46. Rotator Cuff Historical Review.
  47. Rotator Cuff Imaging Techniques.
  48. Rotator Cuff Relevant Anatomy and Mechanics.
  49. Rotator Cuff Tear: When to Repair and When to Smooth and Move the Shoulder
  50. Rotator Cuff Treatment.
  51. SF 36 and Health Status.
  52. Scapulothoracic Positions and Motion.
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  54. Shoulder Arthritis Book
  55. Shoulder and Elbow Cases to Consider.
  56. Shoulder arthritis and rotator cuff tears: The combination of arthritis and rotator cuff tears is called rotator cuff tear arthropathy. The management of this condition requires thought and experience.
  57. Shoulder arthritis: Osteoarthritis, Chondrolysis, Rheumatoid Arthritis, Degenerative joint disease, and arthritis after shoulder surgery.
  58. Shoulder joint replacement arthroplasty for shoulder arthritis pain and stiffness: two options: total shoulder and ream and run
  59. Shoulder osteoarthritis, chondrolysis, rheumatoid arthritis, degenerative joint disease, and arthritis after shoulder arthroscopy and open surgery
  60. Simple Shoulder Test.
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  62. Surface replacement for shoulder arthritis: Surgery with a CAP, a special type of conservative resurfacing joint replacement that resurfaces the ball of the ball and socket joint, can lessen pain and improve function.
  63. Surgery for Atraumatic Instability of the Shoulder.
  64. Surgical release for stiff frozen shoulders: Surgery to remove scar tissue and release contractures can lessen pain and improve function for stiff shoulders that have not responded to rehabilitation or physical therapy.
  65. Total Shoulder Replacement Arthroplasty for Shoulder Arthritis
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  67. Total shoulder joint replacement for shoulder arthritis: Surgery with a dependable, time-tested conservative prosthesis and accelerated rehabilitation can lessen pain and improve function in shoulders with arthritis.
  68. Traumatic Shoulder Instability.
  69. Treating Shoulder Dislocation / Subluxation (Instability) and Associated Pain with Minimally Invasive Arthroscopy
  70. Treatment of Recurrent Instability.
  71. Types of Glenohumeral Instability.