Nerve Pain in Diaphragmatic Injuries with Herniation
Nerve pain is not a recognized or documented clinical feature of diaphragmatic injuries with herniation of abdominal organs such as the stomach, spleen, and small bowel. The available evidence does not support neuropathic pain as a characteristic symptom of these injuries.
Primary Clinical Presentations
The clinical manifestations of diaphragmatic hernias are predominantly respiratory and gastrointestinal in nature, not neuropathic 1:
- Dyspnea (86%) is the most common symptom in traumatic diaphragmatic hernias 1
- Abdominal pain (17%) occurs but represents visceral pain from organ displacement or obstruction, not nerve pain 1
- Gastrointestinal symptoms including intestinal obstruction are particularly common in left-sided hernias 1
- Respiratory compromise results from a 25-50% decrease in pulmonary function due to herniated organs occupying thoracic space 1
Why Nerve Pain Is Not a Feature
The pathophysiology of diaphragmatic hernias involves:
- Mechanical displacement of abdominal organs into the thoracic cavity through a diaphragmatic defect 1
- Visceral complications such as strangulation, volvulus, incarceration, and perforation that cause visceral pain, not neuropathic pain 1
- Cardiopulmonary dysfunction from compression of thoracic structures 1
The diaphragm itself is innervated by the phrenic nerve, but herniation through a diaphragmatic defect does not typically involve nerve injury or compression that would produce neuropathic pain 1.
Associated Injuries in Trauma Cases
In traumatic diaphragmatic injuries, when nerve pain does occur, it is typically from concomitant injuries rather than the diaphragmatic injury itself 2, 3:
- Rib fractures (15% of cases) can cause intercostal nerve pain 3
- Associated musculoskeletal injuries to extremities and pelvis 2
- Multiple organ injuries including liver (43%), spleen (32%), colon (20%), and stomach (17%) 3
Clinical Pitfall to Avoid
Do not attribute nerve pain to the diaphragmatic hernia itself. If a patient with a known diaphragmatic hernia presents with neuropathic pain, investigate for:
- Concomitant thoracic wall injuries (rib fractures, intercostal nerve damage) 3
- Separate musculoskeletal trauma 2
- Unrelated neuropathic conditions
The mortality in diaphragmatic injuries is driven by hemorrhagic shock, associated organ injuries, and complications like bowel strangulation and perforation leading to sepsis—not by nerve injury 1, 3.