Laparoscopy-induced pain is still not fully understood. Background and Objectives: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. The phrenic nerve has anatomical connections with the brachial plexus and the shoulder. Background Shoulder pain is commonly reported after hepatic surgery; however, the factors affecting post-hepatectomy shoulder pain remain unclear. Depending on the extent of the surgery, the pain can last for up to 72 hours. Ways To Relieve Pain After Robotic or Laparoscopic Surgery. Later, a pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure of 60 cmH20. There is a high incidence of shoulder pain after visceral surgical procedures. The doctor may recommend that you take a pain medication to help you recover. The phrenic nerve originates from the anterior rami of C3 through C5 and traverses the neck, heart, and lungs to reach the diaphragm. notice this pain in the first day, but it develops gradually and become severe Even though the CO2 is removed following surgery, the gas can become trapped against the diaphragm, causing pain and discomfort that can then radiate into the shoulder because of pressure on the phrenic nerve. The investigators will follow the patient in the first 48 hours after the surgery. . This is an important piece of information for the health care team to know because they need to know whether your intestines are working properly and whether or not POI is occurring. Phrenic nerve irritation If your phrenic nerve becomes irritated or damaged, you may lose the ability to . The surgeon may also give you a cleansing enema or oral laxative. Great! Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. It can also occur as a result of damage to the peripheral nerves in those areas. A quick phone call to your doctor is a good idea, and you should explain where the trapped gas is. In fact, the acid milieu created by the dissolution of CO. 2. gas causeperitoneal irritation and phrenic nerve WE ARE PLEASED TO HAVE THE ICONIC QUEEN BUILDING LIT IN YELLOW ANNUALLY TO HONOR THE ENDO COMMUNITY. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO2 pneumoperitoneum during laparoscopic surgery. PMC It can also occur as a result of damage to the peripheral nerves in those areas. This gas can irritate the diaphragm and peritoneum, causing pain and discomfort. These may feel like sharp pains in your abdominal area or pelvis. Of course - discuss options with your physician and always contact your surgeon if the pain becomes intolerable or persistent beyond a few days. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level, creating referred pain Background: Your massage therapist may prescribe a Swedish massage, which is a type of massage therapy that targets the diaphragm. Phrenic nerve pain is a complication of laparoscopic surgery. MeSH Maneuvers to Decrease Laparoscopy-Induced Shoulder and Upper Abdominal Pain: A Randomized Controlled Study. To help relieve diaphragm pain after laparascopy, you can practice breathing exercises. To relieve pain after surgery, apply heat to the shoulder area and take prescribed pain medication. Used with permission.Appointments are not made online. Epub 2017 Apr 8. If you own a pair of headphones that you like, bring them to the hospital. Postlaparoscopic pain can be separated into distinct causes, such as surgical trauma- or incision wound-associated inflammatory change . Federal government websites often end in .gov or .mil. How long does gas pain from laparoscopy last? Results: Click the button and find the first one on your computer. The phrenic nerve originates mainly from the 4th cervical nerve, but also receives contributions from the 3rd and 5th cervical nerves (C3-C5) in humans. and transmitted securely. Following laparoscopy 18.5% of 200 patients had sub-phrenic pain on the day of operation and 28% had shoulder pain. Unauthorized use of these marks is strictly prohibited. . 2007 Sep; 62(9):913-8, 3., 7. Entering your story is easy to do. You may also be prescribed an antibiotic. There is a statistically significant correlation between the width of the gas bubble and pain score and this pain can be reduced by aspiration of the gas under the diaphragm by active aspiration, that is repeated suction and manipulation, by the use of a gas drain or by application of local anaesthesia under the diaphragm under direct vision or through a sub-phrenic catheter. Method: This can be too painful for some people, however. remain. Hot packs are safe, but do not apply them directly to your skin. 8600 Rockville Pike and rising up to under the diaphragm, causing the same type of irritation Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which intervention is most effective. One way to relieve phrenic nerve pain after surgery is to drink lots of water and use heat packs. and you really want something to relief it, there are a few things you can do You may feel uncomfortable discussing the topic of passing gas with your health care team, but it is important for them to know that youre farting after surgery. This website is for information purpose only. The https:// ensures that you are connecting to the Cellular Death a normal, regular process by the body to deliberately get rid of unwanted cells, C02 a colorless, odorless gas comprised of one carbon and two oxygen atoms abdominal cavity, Laparoscopy - a minimally invasive surgical procedure used to diagnose and treat endometriosis (among many other disorders), Peritoneal tissue the membrane that forms the lining of the abdominal cavity, Phrenic Nerve innervates the diaphragm and is responsible for, among other functions, breathing, Pneumoperitoneum - surgical creation of a distended abdomen to lift and separate organs (non-surgical pneumoperitoneum = free air in the peritoneal cavity; this is a secondary health concern not addressed or in any way referred to within this article), 1., 4., 5. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. It may also help to rock your knees from side to side. Thank you! Shoulder pain that erupts after laparoscopic surgery is observed due to rise in carbon dioxide in the abdomen which further exerts pressure on the phrenic nerve. Bethesda, MD 20894, Web Policies diaphragm - the dome shaped muscle under both lungs that separates the chest be able to work. Why Does your shoulder hurt after a laparoscopy? However, if you feel some discomfort after the surgery, you should talk to your doctor. The Phrenic Nerve Program is a collaboration between Reza Jarrahy, MD at the UCLA Division of Plastic & Reconstructive Surgery and Matthew Kaufman, MD at the Institute for Advanced Reconstruction. Phrenic nerve pain is often associated with laparoscopic surgery, as it can be caused by the carbon dioxide gas used during the procedure. Take some pain killers like Paracetamol or Tylenol. About 35 percent to 70 percent of patients experience it after surgery. If you can get hold of peppermint oil liquid, many persons have reported Why Does your shoulder hurt after a laparoscopy? The diagnosis of phrenic nerve injury requires high suspicion due to nonspecific signs and symptoms including unexplained shortness of breath, recurrent pneumonia, anxiety, insomnia, morning headache, excessive daytime somnolence, orthopnea, fatigue, and difficulty weaning from mechanical ventilation. the severity and frequency of shoulder-tip pain after laparoscopic surgery [ Time Frame: the first 48 hours . The phrenic nerve contains afferent nerve fibers from the pleura and peritoneum. It happens usually due to irritation of diaphragm while passage of bolus of food. The nerve run downs the neck to the diaphragm, but also branches out to the left shoulder - so the feeling of pain is mistakingly referred out there when the diaphragm . This means that the degenerative damage in your neck can significantly impact the function of one or both vagus nerves. internal bleeding, speak to your doctor immediately. pregnancy who have bled significantly. Your doctor may order an X-ray to determine the cause. When the phrenic nerve is injured, the electrical signals in it stop traveling from the brain to the diaphragm muscle. This review presents an overview of the currently evaluated techniques to reduce . Your nurse will help you to get back to normal. Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial. There are two phrenic nerves, a left and a right one. bleeding, this can easily be identified because you will feel very weak, your After laparoscopic surgery, its common to experience pain in the diaphragm area. should go away within 3 - 5 days. Talk with your doctor and family members or friends about deciding to join a study. Score: 5/5 (66 votes) . Kehrs sign is a classic example of referred pain: irritation of the diaphragm is signaled by the phrenic nerve as pain in the area above the collarbone. Goal Weight: 145 lbs. You can use paracetamol or ibuprofen for the pain you experience following surgery. So your musculature could pinch down and cause a problem with that phrenic nerve. from the abdomen. Shoulder arthroscopy is a minimally invasive procedure that treats shoulder impingement and rotator cuff tears. Heat and pain medications often bring relief. 50% off with $15/month membership. However, these effects will quickly wear off. eCollection 2021 Aug. Kim HY, Choi JB, Min SK, Chang MY, Lim GM, Kim JE. After laparoscopic surgery, it is common for patients to experience shoulder pain. Other treatment options include orthobiologics and physical therapy. In the meantime, patients should apply heat to the affected area and take prescribed pain medication. Fortunately, newer techniques are making it easier to manage this condition. Unfortunately, the use of carbon dioxide (CO2) to insufflate the abdomen is the main contributor to post-operative shoulder pain. . This clinical controlled trial is tried to find out the practical and clinical maneuver to reduce post-operative upper abdominal and shoulder pain after laparoscopic surgery. We would love to hear from you. Gynaecological keyhole surgery (laparoscopy) is a procedure where a surgeon uses a camera (laparoscope) to see inside the lower abdomen to view the uterus (womb), fallopian tubes and ovaries. Postoperative shoulder pain is a common complication of laparoscopic surgery. The phrenic nerve is important for breathing and has both sensory and motor functions. Shoulder pain is a common side effect after laparoscopic surgery. The prolonged presence of shoulder tip pain suggests excitation of the phrenic nerve due to irritation of diaphragm by CO2. Background Laparoscopic surgery has become a standard of care for many gynecological surgeries due to its lower morbidity, pain and cost compared to open techniques. Many times the symptoms are temporary, for example, many patients have nerve problems after surgery that only last for a few weeks to months . A phrenic nerve stimulator is implanted surgically by placing an electrode behind the phrenic nerve, either in the neck or in the chest. It is associated with irritation of the phrenic nerve, which originates from the cervical spine and descends through the thorax to innervate the diaphragm. Firstly, you can avoid pain by taking an over-the-counter analgesic. In fact, ISB may benefit this subset of patients. After your laparoscopic surgery, you may be groggy or dizzy. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level , creating referred pain sensations around the shoulder unilaterally or bilaterally. shoulder pain. Pain occurs in the neck or scapula when the phrenic nerve is irritated 16,17,22. . Do you have some pictures or graphics to add? Right-side diaphragmatic excursion decreased significantly in group P at 1 h postoperatively. This method can help prevent shoulder pain and can also ease diaphragm pain. Dr. Prashant Sinha answered. Pain in the shoulder after laparoscopy is due to irritation of the This is done to create and maintain a distended abdomen; a condition called "pneumoperitoneum." Usually, this is caused by severed, stretched, or compressed nerves. View this study on Beta.ClinicalTrials.gov. Postoperative bloating is also common and should be expected for up to six weeks. Choi YM, Byeon GJ, Park SJ, Ok YM, Shin SW, Yang K. J Clin Anesth. Causes And How To Relief Shoulder Pain After Surgery. Current Weight: 189 lbs. Other possible causes of phrenic nerve injury include birth trauma, surgery, and infection. They need to know whether your intestines are functioning well, and if any POIs are occurring. This will help prevent shoulder pain. Consult Now. With each dive I feel like I meet my Maker. This inflammation can lead to sharp, achy pain. . It Randomised prospective study comparing the incidence of postoperative pain after phrenic nerve infiltration vs non-phrenic nerve infiltration on open thoracotomy - initial results Summary. Though more common in children, it can occur in. This gas can irritate the diaphragm and the phrenic nerve, which has nerve endings in the shoulder. Once you are fully awake, youll receive post-operative instructions, including how to keep the wounds clean and when to come for follow-ups. To receive credit as the author, enter your information below. Thoracic diaphragm and visceral therapy should be considered in shoulder pathology. The phrenic nerve is among the most important nerves in the body due to its role in respiration. Warm bath and hot drink. What can you not do after laparoscopic surgery. This pain may last for a few days. This nerve has sensory, motor, and sympathetic functions. Postoperative pain caused by gas is the most common and most unpleasant experience for patients after laparoscopic surgery. Our Customer Services Team are here to help with all of your inquiries during institute opening hours. The diaphragm muscle turns off and the patient may have difficulty breathing. Cholecystectomy; Laparoscopic; Nerve block; Phrenic nerve; Shoulder pain; Ultrasonography. It begins at the C3 vertebra, which aligns with the jaw and rotates the neck. There is marked interindividual variability of post-operative shoulder-tip pain following laparoscopic surgery. -, Anesth Pain Med. Current Weight: 178 lbs. Just type!Your story will appear on a Web page exactly the way you enter it here. The incidence of such pain varies from 35%-83% across patient populations, ranging from mild to severe, and in some cases, the pain has been reported to last even longer than 72 hours post-operatively (though this is less common).1 Moreover, in nearly 70% of cases studied, patients experienced the worst pain not immediately post-operatively - but up to 24 hours aftertheir surgery.2 Read on to find out why this occurs - and what we have been doing for years at our Center to help effectively reduce and diminish this pain in our own patients.To begin, during Laparoscopy,CO2 (carbon dioxide) gasis injected through a special needle inserted just below your navel. The phrenic nerve contains afferent nerve fibers from the pleura and peritoneum. But if surgical work was done in the pelvis, why is there pain at the shoulder tip?? The phrenic nerve has anatomical connections with the brachial plexus and the shoulder. In some cases, it has been reported to last more than 72 hours after surgery. The purpose of this study was to compare the . While it can be uncomfortable, the pain will pass on its own. Although most patients report minimal pain after laparoscopic surgery, about 35 to 70% of patients complain of shoulder pain. Image (c) by www.laparoscopy.am. Have as much rest as possible. This can help the surgeon pinpoint the cause of the pain. 2011 Jul;40(1):106-12. doi: 10.1016/j.ejcts.2010.10.025. The CO2 is inhaled at 70degF, and the effect it has on the diaphragm results in pain and discomfort. Phrenic nerve pain is a common complication following laparoscopic surgery. A ruptured spleen can cause pain in the left shoulder because bleeding from the spleen may irritate the phrenic nerve, a nerve that originates in the neck and extends through the diaphragm. Rarely, shoulder pain after laparoscopy could be due to internal The phrenic nerve provides the primary motor supply to the diaphragm, the major respiratory muscle[1]. You can also use a heat pack on your lower abdomen to help with the pain. My thesis aimed to study dynamic agrivoltaic systems, in my case in arboriculture. Journal of the International Society for Gynecologic Endoscopy. 33.5. It can also be caused by an inflammatory or autoimmune disease. A support pillow can also help. Irritation to the diaphragm may cause a person to feel pain in the shoulder area. Entering your story is easy to do. Laparoscopic surgery is becoming a major procedure, owing to smaller incisions, shorter hospitalizations, and less post-operative pain as compared with traditional laparotomies. Although it is generally temporary, shoulder pain may persist for a few weeks or even months. The result is irritation of the phrenic nerve and diaphragm, causing referred pain in the . Guaranteed. Recruitment manoeuvres (RM) consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome (ARDS). A pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure of 60 cmH2O. This site needs JavaScript to work properly. Additionally, hot tea can stimulate gastrointestinal motility and help you relieve painful gas pains. Evidence suggests that shoulder pain after laparoscopy mainly occurs due to the irritation of the afferent nerve fibers of the diaphragm phrenic nerve, induced by the residual CO 2 , blood, or . Co2 was removed by passive exsufflation through the port site. Shoulder pain is a common side effect after laparoscopic surgery. The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients. Unless the phrenic nerve is injured on both sides, making the patient unable to breathe on his or her own, this is often an elective treatment situation. to help. Postlaparoscopic shoulder pain is a common side effect of surgery. In obese patients with short neck, . Heat packs and moving around should help to relieve the pain. Diet changes: Hiatal hernia surgery usually includes a stomach wrap (fundoplication). The Phrenic nerve arises on each side of the neck, from the 3rd, 4th and 5th cervical spine roots. Keywords provided by Taipei Veterans General Hospital, Taiwan: Procedure: Pulmonary recruitment maneuver, Procedure: Intraperitoneal normal saline infusion. The upper part of the abdominal cavity was evenly and bilaterally filled with the 0.9% normal saline in the amount of 500cc. Shoulder pain after pelvic peritonoscopy can be reduced by both lignocaine or bupivacaine i.p., and the addition of adrenaline permitted a large volume to be used without approaching systemic toxicity. When you register, the WLH reserves specific class space for you and commits resources to provide the Hands On Course you have selected. FOIA Alternatively, try gently pushing yourself to have a bowel movement. heart rate will be very fast, your blood pressure will be low, you will be In addition, you should drink lots of fluids and avoid constipation. In some cases, the damaged nerve may heal on its own, but patients need to understand this isnt an unlimited window. However, these side effects are likely to disappear quickly, and you should be able to resume normal activities in a few days. pain in one or both of their shoulder. Listing a study does not mean it has been evaluated by the U.S. Federal Government. This pain can be caused by irritation of the phrenic nerve, which is located in the diaphragm. It sends signals to the diaphragm to contract and expand, which helps the lungs breathe. 2015 Dec 05;5(6):e31524 Potential symptoms of damage to the vagus nerve include: These muscles can get very tight and atrophied when you have any cervical instability, forward neck carriage, or a chronic problem with your neck. You will get pain medication after your surgery. In many cases, it can be treated with numbing agents. Phrenic nerve irritation Irritation or injury to this nerve, or any inflammation, can trigger spasms in the diaphragm in addition to causing hiccups and breathing difficulties. Surgical procedures affecting the phrenic nerve can cause pain. It originates in the neck and travels to the diaphragm, where it gives off pain. double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery. Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy. After four hours, you can begin walking or at least climbing stairs. This time . Do you have some pictures or graphics to add? However, this pain should pass on its own in a couple of days. The pain is then referred upward through the nerves until it lands in the shoulder. The saphenous nerve is the sensory component of the femoral nerve after it enters the adductor canal, and it provides sensory innervation to the medial aspect of the ankle. The right phrenic nerve runs superficial to the anterior . This article will discuss how to relieve phrenic nerve pain after surgery. The phrenic nerve is a mixed nerve arising from the anterior rami of C3-C5 spinal nerves, which are components of the cervical plexus.It arises in the neck and descends vertically through the thorax to end on the diaphragm.The phrenic nerve is a bilateral nerve, and its left and right counterparts have some important differences in terms of course and relations with surrounding structures. The etiology of pain after laparoscopic cholecystectomy is multifactorial (9). The residual CO2 causes pressure on the nerve, which in turn, causes the pain. After surgery i keep my patients on pured foods to allow the stomach to heal.. Read More. There is a high incidence of shoulder pain after visceral surgical procedures. Phrenic nerve damage symptoms. A small amount of it dissolves in the moisture on the surface of the You should also be aware that some pain medications may cause nausea, so make sure to notify your physician. Neurologist: no it shouldn't. Plus the phrenic nerve is on the left side of the abdomen and her liver surgery would have been on the right side so I doubt that this is phrenic nerve damage. eating spicy foods. However, it is actually caused by cellular death, which is part of the wound-healing process. Its a type of nerve pain that feels like pins and needles. Please contact our offices directly for assistance. The phrenic nerve has anatomical connections with the brachial plexus and the shoulder. The PFT results and respiratory discomfort assessed by a modified Borg's scale were not different significantly between the groups. Up to 80% of these women may experience shoulder-tip pain (STP), which may be very painful and lead to longer stays in hospital and even having to go . I love to write and share science related Stuff Here on my Website. It is due to the gas In particular, carbon dioxide-induced Phrenic nerve irritation causes referred pain to cervical nerve 4 (C4). Sodium Bicarbonate Sub-Diaphragmatic Irrigation Relieves Shoulder Pain After Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. Pleurisy Pleurisy refers to inflammation of the pleura, which is the layer of tissue on the inner side of the chest cavity surrounding the lungs. It can result from irritated diaphragmatic nerves. What caused it? Chronic nerve pain after surgery is sometimes called surgically-induced neuropathic pain (SINP). Trapped gas is a common postoperative complaint, and it can persist for months after the surgery. visceral pain. Epub 2010 Dec 8. -, Minerva Chir. You can also try heating pads, but you should avoid placing them on numb skin. Also, remember to drink lots of fluids and avoid constipation. Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. There is a high incidence of shoulder pain after visceral surgical procedures. These pillows can help reduce the discomfort associated with gas pain. A randomized clinical trial on the effect of a lidocaine patch on shoulder pain relief in laparoscopic cholecystectomy. While doctors usually discuss the vagus nerve in singular sense, there are two vagus nerves, one on each side of the neck and in combination they are referred to as the vagal nerves. Dr. Rahul Poddar. Anaesthesia. Consult privately with the doctor of your choice. Weight Lost: 79 lbs. weakness and shortness of breath. Keywords: Ask a doctor any question online now and get answers within minutes. Would you like email updates of new search results? It feels like someone is stabbing me with a piece of rebar (the metal poles in concrete) and just . upper subscapular nerve from the border of the glenoid is 3.9 cm with the shoulder in internal rotation, 3.3 cm with the shoulder in neutral, and 2.5 cm with the shoulder in external rotation. Next Steps. The patient may also feel pain in the shoulder and back. You can take up to World Laparoscopy Hospital, Cyber City, DLF Phase II, Gurugram, NCR Delhi, 122 002, India PHONES: For Training: +919811416838 For Treatment: +919811912768 For General Enquiry: +91(0)124 - 2351555 Email: contact@laparoscopyhospital.com. It can also be affected by surgical procedures. Obstet Gynecol. You can expect gas pains for several days following surgery. What is the ICD-10-CM code for skin rash? We have demonstrated that this pain can be reduced through the effective techniques we practice, including not only removal of the C02 before the end of the procedure but, importantly, heating and humidifying the gas, which prevents cellular death and quite simply, results in less shoulder pain.7We always utilize the latest technology and surgical practices to minimize pain and recovery time for all of our patients, including (but not limited to) use of Insuflow technology. The pain can be relieved by applying heat to the area. Alternatively, the patient can lie down and watch TV or listen to music. If you experience these, try gently massaging your tummy to release trapped gas. Muscular disorders, such as muscular dystrophy. Intraoperative chest fluoroscopy is performed to . In severe cases, it can even result from a spinal cord injury. Nerves Regulate Breathing The phrenic nerve is actually a pair of nerves, the right and left phrenic nerves, that activate contraction of the diaphragm that expands the thoracic cavity. lasts for more than 5 days. U.S. Department of Health and Human Services, The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Let's review the causes and treatment of this annoying pain after undergoing a keyhole or laparoscopic surgery as well as what can be done to reduce such pain. Elevation is another helpful method. Unable to load your collection due to an error, Unable to load your delegates due to an error. It can result from a partial or complete transection of the nerve. The Minimal Access surgery course was created in a manner that after this program surgeon & gynecologist will be able to do all the taught surgery their own on their patients. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level , creating referred pain sensations around the shoulder unilaterally or bilaterally. Is this common? All the nerve branches are no closer than 1.5 cm me-dial to these land-marks for all positions of humeral rotation with the arm at the side. The most common symptoms of nerve damage after surgery are usually numbness, tingling, burning, muscle weakness or atrophy. Before How do I get rid of gas pain in my shoulder? Unexplained shoulder and arm pain can sometimes be a warning sign of a heart attack. Cover photo AJ Arend. Arch Surg. The phrenic nerve is one of the four major nerves that run through the diaphragm. However, it will subside on its own. confused and thinks that the signal of irritation or pain is coming from the Symptoms typically improve when you are in a sitting or standing position. Gas pain can occur after abdominal surgery, and it can start in the shoulder and back. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level, creating referred pain sensations around the shoulder unilaterally or bilaterally. Shoulder pain after laparoscopy is very common. Alopecia is an immuno-disorder whereby your immune system mistakenly attacks your hair follicles, causing them to become inflamed, resulting in ultimate hair loss. 1996 Nov;77(5):576-80 You can wrap a word in square brackets to make it appear bold. Pinched Nerve in the Thoracic Spine Often caused by an acute injury or accident, a thoracic compressed nerve causes pain in the upper back, chest and torso. Your physician will give you instructions on how to care for the incision and wounds and when to return for follow-up. Hence, patients suffering spinal cord injuries below the neck are still able to breathe effectively, despite any paralysis of the lower limbs.