On the shoulder-tip pain, and other sympathetic pains, in diseases of the liver / by D. Embleton.
- Dennis Embleton
- Date:
- 1870
Licence: Public Domain Mark
Credit: On the shoulder-tip pain, and other sympathetic pains, in diseases of the liver / by D. Embleton. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![direct passage of phrenic twigs to tlie porta of the liver, and round ligament given in any book (see Ellis and Swan),* but if present, they are maintained by very small twigs, which are not accessible to examination, and it would be extremely dilHcult, if not impossible,to prove that the shoulder pains in liver disease are located in the phrenic nerve and its branches. This nerve does not appear to give off any other branches in the neck, except those to the sympathetic, and to the subclavius muscle.’f' It is true tliat there are, at times, pains in or close to the clavicle in some cases of hepatic disease, and possibly tliey may be accounted for by the connections pointed out or alluded to by Sir Thomas Watson, Mr. Hilton, and Professor llolleston, but the ordinary seat of the shoulder-tip pain is not in the clavicle, but in the edge of the trapezius muscle behind it, as will presently be pointed out, and the above ex[)lanation does not, therefore, answer for this pain. Now, there exists an important, though a somewhat distant, line of nervous connection between the liver and the top of the shoulder—one that has not hitherto been noticed in print— but by means of which a more intelligible and satisfactory ex])lanation is capable of being given of the occurrence of till' shoulder-tip pain in liver dise.ases; and, by submitting the following observations, noted before special reference was made to what had been previously written on the subject, I shall best be able to show the line of connection just referred to. These observations were made on cases of hepatic congestion with enlargement, of cancer of the liver, and of passing gall- stones, cases which had, from time to time, come under my notice in public and in ])rivate practice ; and with regard to the fns^uency of the pain at the shoulder-tip, 1 had come to a conclu.sion the reverse of that stated by Andral, Budd, and others. It appeare to me to occur more fretiuently than is generally believed. That it is seldom severe, I agree ; but that it is often present in some degree, though little complained of by patients, and will be discovered, on investigation, to exist, I feel sure. The pain, when present and well marked, occurs at tlie top of the shoulder, being referred especially to the angular space * “ ()ne or two lilaments of the dght nerve join in a small ganglion, wi h branches to the diaplmigm, which are derived from tlie solai-ple.vus of the svmpathetic; and from the ganglion twigs are. given to the .supi-areiiiil capsule, the hepatic jrle.xus, and lower vena cava.'—(t^uain, &c., 7th Edit., jiart ii., p. f>41.) ,. .. ■ j » ^ -u'l-*- iqcc i .‘V subclavian twig is not mentioned in Qiiaiii s Auat., 7th Edition, lobo.](https://iiif.wellcomecollection.org/image/b22471911_0016.jp2/full/800%2C/0/default.jpg)
