Shoulder-hand Syndrome
Original Editor - Essam Ahmed
Top Contributors - Essam Ahmed, Mahnoor Zubair and Kim Jackson
Definition and Causes
Also known as Post-stroke complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy of upper limb[1]. Shoulder-hand Syndrome (SHS) is a multifactorial disorder[2]characterized by edema and swelling of the hand, hyperalgesia, sever pain and loss of function in the shoulder joint with changes in the skin color and temperature[3][4].The cause is still unknown, but it may be due to one or multiple causes which include[2][5]
- Prolonged immobility.
- Repeated minor trauma from blood drawing and intravenous injections.
- Angio-spasm
- Perceptual deficit
- Central sympathetic dysregulation and neurogenic inflammatory reactions
Complex Regional Pain Syndrome
Shoulder-hand syndrome is also known as Complex Regional Pain Syndrome (CRPS) which is a chronic pain condition with features of both autonomic and inflammatory syndromes. It presents acutely in approximately 7% of patients after limb fractures, surgeries, or other injuries. Most cases resolve spontaneously during the first year; however, some advance to the chronic pattern. This also often marks the transition from "warm CRPS" with prominent inflammatory symptoms to "cold CRPS" that is dominated by autonomic features. [6]
Symptoms and Signs
A definite SHS diagnosis should include the following symptoms[5]:
| Site | Symptoms and Signs |
|---|---|
| Shoulder | Loss of ROM; pain and tenderness elicited by these motions or in rest |
| Elbow | Usually no symptoms |
| Wrist | Considerable pain on extension; tenderness to deep palpation and dorsal oedema over carpal bones |
| Hand | little pain or tenderness; oedema overlying metacarpals |
| Digits | Considerable pain on flexion of metacarpal-phalangeal and interphalangeal joints; moderate oedema and loss of dorsal skin lines; changes in hair and nail growth; vasomotor and changes in temperatute, colour and hidrosis |
Interventions
The intervention is Multidisciplinary approach that include :
- Medication[5][1]: NSAID, Oral Corticosteroid, Shoulder Steroid Injection.
- Physical Therapy.
Physiotherapy
It is effective in improving sensory-motor function and reducing pain and edema in the upper limb in post-stroke patient.
A functional shoulder orthoses helps prevent and shoulder subluxation in post-stroke patients and reduces the risk of shoulder-hand syndrome.
Shoulder orthosis or shoulder brace, prevents subluxation-that is, partial dislocation-by providing support and stability for the shoulder joint. This is highly important for patients with hemiplegia due to a stroke; rotator cuff damage; nerve damage which may seriously weaken the muscles and ligaments round the joint.
It works by improving the following areas:
- Joint Alignment
- Muscle Support
- Pressure Distribution
- Pain Reduction
- Enhanced Proprioception
Combined with a rehabilitation program, Acupuncture helps reduce the pain, Improves upper limb function and the activity of daily living compared with rehabilitation program alone.
- Maintain R.O.M. and function of the shoulder and hand.
- Reduces pain and edema in the hand.
Effective in reducing pain and edema in the affected hand and shoulder, improves R.O.M. and Promotes Independency in post-stroke patients.
Helps in reducing pain in the affected hand and shoulder and promote R.O.M.
In Bayesian network meta-analysis, EMG biofeedback integrated with rehabilitation training was the most effective approach regarding all types of physical therapy for improving upper limb motor function and relieving pain in patients diagnosed with post-stroke shoulder-hand syndrome. But, further analysis and validation is necessary in more qualitative randomized controlled trials.
References
- ↑ 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).
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Bruehl S. Complex regional pain syndrome. Bmj. 2015 Jul 29;351.
- ↑ 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.
- ↑ 8.0 8.1 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.
- ↑ Feng S, Tang M, Huang G, Wang J, He S, Liu D, Gu L. EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: a Bayesian network meta-analysis. Frontiers in Neurology. 2023 Jan 10;13:1056156.