title: Shoulder Pain After Thoracic Surgery: Type and Time Course, a Prospective Cohort Study.
abstract: OBJECTIVE
  To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  Odense University Hospital, Denmark.
  
  
  METHODS
  Sixty patients for major lung resection.
  
  
  METHODS
  Postoperative observation of ipsilateral shoulder pain.
  
  
  RESULTS
  Postoperative numeric rating scale score of shoulder pain and thoracic pain and postoperative examination of the sites of shoulder pain for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45%) who suffered shoulder pain of the musculoskeletal type. Shoulder pain of the musculoskeletal type was significantly more intense (p = 0.0008) than referred shoulder pain.
  
  
  CONCLUSIONS
  Only a subset of patients has clinically relevant shoulder pain after postoperative day 2. Chronic shoulder pain is a minor problem after lobectomy and previously may have been overestimated. Ipsilateral shoulder pain of the musculoskeletal type is more intense than referred ipsilateral shoulder pain.
authors: Department of Anesthesiology, Vejle Hospital, DK-7100 Vejle, Denmark; Departments of Anesthesiology and Intensive Care Odense, Denmark. Electronic address: mr.be@rsyd.dk.
authors: Morten R
authors: MR
authors: Blichfeldt-Eckhardt
authors: Departments of Anesthesiology and Intensive Care Odense, Denmark.
authors: Claus
authors: C
authors: Andersen
authors: Department of Anesthesiology, Vejle Hospital, DK-7100 Vejle, Denmark.
authors: Helle
authors: H
authors: Ørding
authors: Cardiothoracic Surgery, Odense University Hospital, DK-5000 Odense, Denmark.
authors: Peter B
authors: PB
authors: Licht
authors: Departments of Anesthesiology and Intensive Care Odense, Denmark.
authors: Palle
authors: P
authors: Toft
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology*; D053591:Referred Pain / Q000209:etiology; D011446:Prospective Studies; D020069:Shoulder Pain / Q000209:etiology*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D013908:Thoracotomy / Q000009:adverse effects
keywords: ipsilateral shoulder pain; postoperative pain; referred pain; thoracic surgery; thoracotomy