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.

中文翻译：

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膈神经对肩痛的影响：系统评价

摘要 目的描述神经与臂丛神经和肩部的解剖连接。描述内脏外科手术中疼痛的发生率和起源。数据来源 使用四个数据库进行系统审查：1998 年至 2018 年的 PubMed、Science Direct、Web of Science 和 Scopus。研究选择和数据提取 2 个搜索字符串用于实现目标：a) 尸体研究中膈神经的节段起源， 5 研究。b) 内脏外科手术（开胸、腹腔镜和剖宫产）后的肩痛及其与膈神经的关系，26 项研究。两名独立审查员应用了选择标准并使用尸体研究质量评估 (QUACS) 量表进行观察性研究和物理治疗证据数据库 (PEDro) 量表进行实验性研究来评估研究质量。第三位审稿人在未达成共识的情况下进行干预。数据综合 膈神经的节段起源有多种变化，C3-C4-C5 神经根在与臂丛神经有重要连接的研究中最常出现。内脏手术后肩部疼痛的发生率很高。大多数研究中最常见的理论提出，肩部区域的疼痛是通过膈神经传导的。