Definition and Causes
Also known as post-stroke complex regional pain syndrome or upper extremity reflex sympathetic dystrophy [1]. Shoulder-hand syndrome (SHS) is a multifactorial disorder [2] characterized by hand hyperalgesia, severe pain, and loss of shoulder function as well as hand edema and swelling Skin color and temperature [3][4]. The cause is still unknown, but may be due to one or more causes, including [2][5]
- Prolonged immobility.
- Repeated minor trauma from blood draws and intravenous intubations.
- Angio-spasm
- Perceptual deficit
- Central sympathetic dysregulation and inflammatory arthritis
Symptoms and Signs
The definitive diagnosis of SHS should include the following symptoms[5]:
SiteSymptoms and SignsLoss of shoulder ROM; pain and tenderness caused by this movement or at restElbowUsually asymptomaticWristPain maximal on extension; moderate weakness to touch and external numbness on finger bonesHandlittle pain or tenderness; overlying edema metacarpalsDigitsSignificant pain at the flexion of the metacarpal-phalangeal and interphalangeal joints; moderate edema and loss of outer skin fibers; changes in hair and nail growth; vasomotor and changes in temperatute color and hidrosis
Interventions
The intervention is a Multidisciplinary approach which includes :
- Drugs[5][1]: NSAID Oral Corticosteroid Shoulder Steroid Injection.
- Physical Therapy.
Physiotherapy
- Mirror Therapy[5][1]
It has obvious curative effect on improving the sensorimotor function of post-stroke patients and reducing upper limb pain and edema.
- Orthoses[4]
Functional shoulder orthoses help prevent shoulder subluxation in post-stroke patients and reduce the risk of shoulder-hand syndrome.
- Acupuncture[6][3]
When combined with a rehabilitation program, acupuncture can help reduce pain and improve upper extremity function and activities of daily living compared to a rehabilitation program alone.
- Passive and Active R.O.M.[5]
- Maintain R.O.M. and function of the shoulders and hands.
- Reduces pain and edema in the hand.
- Laser[7]
Effectively reduces pain and edema in affected hands and shoulders, improves R.O.M. and promotes independence in post-stroke patients.
- T.E.N.S.[7]
Helps relieve pain in affected hands and shoulders and promotes R.O.M.
References
- ↑ Jump up to:1.0 1.1 1.2 Saha S, Sur M, Ray Chaudhuri G, Agarwal S. Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder‐hand syndrome: A randomized controlled trial. Physiotherapy Research International. 2021;26(3).
- ↑ Jump up to:2.0 2.1 Kondo I, Hosokawa K, Soma M, Iwata M, Maltais D. Protocol to prevent shoulder-hand syndrome after stroke. Archives of Physical Medicine and Rehabilitation. 2001;82(11):1619-1623.
- ↑ Jump up to:3.0 3.1 Liu S, Zhang C, Cai Y, Guo X, Zhang A, Xue C et al. Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Neurology. 2019;10.
- ↑ Jump up to:4.0 4.1 Hartwig M, Gelbrich G, Griewing B. Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post-hemiplegic shoulder–hand syndrome: a randomized clinical trial. Clinical Rehabilitation. 2012;26(9):807-816.
- ↑ Jump up to:5.0 5.1 5.2 5.3 5.4 C. H Geurts, B. A. J. T. Visschers, A. Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome. Scandinavian Journal of Rehabilitation Medicine. 2000;32(1):4-10.
- ↑ Peng L, Zhang C, Zhou L, Zuo H, He X, Niu Y. Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis. Clinical Rehabilitation. 2017;32(4):429-439.
- ↑ Jump up to:7.0 7.1 Karabegović A, Kapidžić-Duraković S, Ljuca F. Laser Therapy of Painful Shoulder and Shoulder-Hand Syndrome in Treatment of Patients after the Stroke. Bosnian Journal of Basic Medical Sciences. 2009;9(1):59-65.
