Ipsilateral shoulder pain (ISP) after thoracic surgery is a common complication. This article provides a comprehensive review of the mechanisms, influencing factors, and current treatments related to ISP. The predominant hypothesis regarding the mechanisms of ISP is the secondary pain caused by surgical stimulation of the pericardium, mediastinum, or pleural surface transmitted through the phrenic nerve. The main influencing factors of ISP include body mass index, intraoperative positioning, surgical approach, operative time, and stimulation from the chest drainage tube. Phrenic nerve blockade is an effective treatment for ISP. The role of suprascapular nerve blockade, interscalene brachial plexus blockade, and intrapleural blockade in reducing the incidence of ISP is briefly described. The mechanisms of ISP are still unclear, and further research is needed to confirm these mechanisms and explore better treatment options.