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Influence of the phrenic nerve in shoulder pain: A systematic review

Journal: International Journal of Osteopathic Medicine Date: 2020/04, . doi: Subito , type of study: systematic review

Full text    (https://www.journalofosteopathicmedicine.com/article/S1746-0689(19)30031-8/fulltext)

Keywords:

brachial plexus [8]
diaphragm [73]
phrenic nerve [4]
shoulder pain [24]
visceral afferents [1]
visceral pain [2]
visceral afferent nerve [1]
thoracic viscera [1]

Abstract:

Objectives: To describe the anatomical connections of the nerve with the brachial plexus and the shoulder. To describe the incidence and origin of pain in visceral surgical procedures. Data sources: Systematic review using four databases: PubMed, Science Direct, Web of Science and Scopus from 1998 to 2018. Study selection and data extraction: 2 search strings were used to meet the objectives: a) segmental origin of the phrenic nerve in cadaveric studies, 5 studies. b) shoulder pain after visceral surgical procedures (thoracotomies, laparoscopies and cesarean sections) and its relation to the phrenic nerve, 26 studies. Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Quality Appraisal for Cadaveric Studies (QUACS) scale for observational studies and the Physiotherapy Evidence Database (PEDro) scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. Data synthesis: There are variations in the segmental origin of the phrenic nerve, with the C3-C4-C5 roots appearing most frequently in studies with important connections to the brachial plexus. There is a high incidence of pain in the shoulder after visceral surgery. The commonest theory in most of the studies proposed that the pain referred to the shoulder region was via phrenic nerve conduction. Conclusion: Surgical processes that affect the thoracic viscera and the relations with the peritoneum can produce symptomatology of referred pain by the nervous system (phrenic nerve) and must be considered in multidisciplinary approach of the patient with shoulder pathology.


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