Incidence and risk factors of ipsilateral shoulder pain in patients after thoracic surgeries

Ipsilateral shoulder pain (ISP) post-thoracotomy impairs the recovery in early postoperative period, the aetiology of which is unclear. We studied to find out the incidence and risk factors associated with ISP.

We did a prospective observational study, wherein 296 patients scheduled for thoracic surgeries were enroled. Pain in the shoulder during activity was assessed using American Shoulder and Elbow Surgeons standardised assessment method. All potential predictors were analysed in a multivariable penalised logistic regression model, using ISP as the outcome variable.

Of the 296 patients, 118 (39.8%) patients developed ISP. Of the 296 patients, 170 patients underwent thoracotomy and 110 underwent video-assisted thoracoscopic surgeries. The incidence of ISP was higher in thoracotomy patients (45.29%) compared to video-assisted thoracoscopic surgeries (32.7%). Majority of patients (43.2%) were aged more than 65 years, which was statistically significant as per univariate analysis (P = .007). The incidence of ISP was the highest at 41.89% among those who had lung cancer (n = 74), with disease involving right upper lobe and left upper lobe, 29% and 25.8%, respectively. The pain severity was moderate in 27.1% of patients during shoulder movements. Among the patients who had ISP, 77.1% expressed it as dull aching, whereas 21.2% described it as stabbing in nature.

The incidence of ISP in those who underwent thoracic surgery was high and dull aching in nature, of mild to moderate intensity, commonly located on the posterior aspect of the shoulder. It was more common in those who underwent thoracotomy and more than 65 years of age.