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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![between the acromial end of the spine of the scapula, and the adjacent end of the clavicle, where the upper and outer j>art of the trapezius muscle, as it goes to be inserted into the bones just named, is lodged. At this ]>art, the external division of the Spinal xVccessory nerve, after liaving supplied the sterno-cleido- mastoid, and anastomosed with the second and third cervical nerves, enters the trapezius, forming a small plexus with twigs of the third and fourth cervical nerves, aiid is continued on along the vertebral border of the scii[)ula, supjdying the trapezius in its course, and communicjiting with twigs of the intercostal nerves. It occurs often when there is much pain in the liver. It varies in intensity from a feeling of weight, or dull aching, to a sluirp, lancinating, darting, or boring pain, and then the part at which it is felt becomes more or less tender on pressure, (but no swelling or rednes.s, as Dr. Budd Invs stated, is observable). It appears to be severe in proportion to the degree of pathological (hypenemic or inflammatory) disturbance I'aging in the liver, and is at times accompanied with pains passing from the liver up into the interior of the chest, and the liver itself is very tender on pressure. When not severe, it appears confined to the shoulder-tip; when severe, it shoots downwanls to the lower angle of the scapula, and occasionally oblujuely u[)ward-! along the side of the neck, as far as the base of the skull, in front of the vertebral column, or, in other words, along the track of the external division of the spinal accessory nerve, the only nerve lying in that direction. In a case favourable for observation, a little examination will show that this nerve is really tender to pressure from the seat of pain at the .shoulder-tip u[) to that j)ai t of the sterno- cleido-mastoid nm,scle through which the nerve is known to pass, and also thence as far towards tlie base of the skull as it is accessible to pressure. This muscle is tender where the nerve passes through, if its deeper h.yers are moderately pinched up, but above and a little wa^^ below the line of transit of the nerve the muscle is not at all tender to pressure. The trunk of the Pneumoga.stric nerve also of the .same side will be found, in such a ca.se, abnormally sensitive to pres.sure, and it will be .so in jmiportion to the amount of pain in the shoulder, and to the tenderness of the spinal acces-<ory; and the sen.sitivene.s.s will be found greater as we trace the iierve down to the cla\ icle, at a little below the level of M^hich the nerve ceases to be amenable to examination ; upwards in the](https://iiif.wellcomecollection.org/image/b22471911_0017.jp2/full/800%2C/0/default.jpg)
