Shoulder-hand Syndrome

Original Editor - Essam Ahmed

Top Contributors - Essam Ahmed  

Definition and Causes[edit | edit source]

Also known as Post-stroke complex regional pain syndrome 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]

  1. Prolonged immobility.
  1. Repeated minor trauma from blood drawing and intravenous injections.
  2. Angio-spasm
  3. Perceptual deficit
  4. Central sympathetic dysregulation and neurogenic inflammatory reactions

Symptoms and Signs[edit | edit source]

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[edit | edit source]

The intervention is Multidisciplinary approach that include :

  • Medication[5][1]: NSAID, Oral Corticosteroid, Shoulder Steroid Injection.
  • Physical Therapy.

Physiotherapy[edit | edit source]

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.

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.

  1. Maintain R.O.M. and function of the shoulder and hand.
  2. 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.

References[edit | edit source]

  1. 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. 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. 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. 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. 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.
  6. 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.
  7. 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.