Postthoracotomy shoulder pain: diagnosis and management.

PURPOSE OF REVIEW: The review will discuss postthoracotomy/scopy ipsilateral shoulder pain, a common, intense and distressing outcome of chest surgery. This review will highlight some of the diagnostic vagaries in the current literature and present an argument for the etiology of this pain. In addition, perioperative management will be discussed. Evidence will be presented that effective prevention and treatment is possible for this pain entity. A multimodal management strategy for prevention and treatment of postthoracotomy/scopy ipsilateral shoulder pain is proposed. Finally, this review will highlight potential areas for investigation. RECENT
FINDINGS: Studies of postthoracotomy/scopy ipsilateral shoulder pain are few and the etiology of the pain is not clearly understood. Recent randomized studies of treatments for this pain entity have implicated the phrenic nerve in the genesis of this pain syndrome. Prospective studies of the natural history of this pain syndrome have also highlighted other sources of the pain.
SUMMARY: A picture is emerging of a pain syndrome that may be intense but is relatively limited in duration. The effect of this pain on overall perioperative morbidity is not known. Potential areas for investigation including studies to determine risk factors for postthoracotomy/scopy ISP are discussed.