The dual etiology of ipsilateral shoulder pain after thoracic surgery⋆

Post-thoracotomy shoulder pain and gabapentin: a tale of two enigmas

“…These findings are consistent with other case reports. 7 As well, while Scawn et al 8 and Danelli et al 9 demonstrated a significant reduction in post-thoracotomy SP, following injection of local anesthetic into the peri-phrenic nerve fat pad, a significant number of their patients continued to experience post-thoracotomy SP. Therefore, there is suggestion that post-thoracotomy SP, in a subset of patients, may originate from sources other than the phrenic nerve.…”

“…Ces résultats coïncident avec d'autres présentations de cas. 7 En outre, bien que Scawn et coll. 8 et Danelli et coll.…”

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

“…Postthoracic surgery ISP is reported as moderate to severe in the majority of patients [3, 6, 8, 15–18]. In approximately half of the patients, ISP was located at the posterior side of the shoulder [6], but it may be felt around the deltoid region [16, 18], the superior-posterior area of the shoulder [3], or the lateral third of the clavicle [17]. All those areas share innervation from C4 and C5 with the diaphragm.…”

“…While the majority of reports define the pain as independent from movement [3, 11, 16, 18], other reports describe ISP to be aggravated by movement [17]. However, effective treatment of pain will decrease ISP severity, both during rest and cough [9].…”

“…There are many unproved or partially proved hypotheses regarding the etiology of ISP including transection of major bronchi, ligament distraction or strain as the result of surgical retraction, shoulder joint strain from intraoperative mal-positioning, myofascial involvement, irritation of the pleura by chest drains, and referred pain from irritation of the pericardium, mediastinum, or diaphragmatic surface [3, 5, 11, 17, 20, 21]. …”