Shoulder-hand Syndrome: Difference between revisions

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== Definition and Causes ==
== Definition and Causes ==
Also known as Poststroke complex regional pain syndrome or reflex sympathetic dystrophy of upper limb<ref>[https://onlinelibrary.wiley.com/doi/full/10.1002/pri.1902 Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial]</ref>. Shoulder-hand Syndrome (SHS) is a multifactorial disorder<ref>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.</ref>
Also known as Poststroke complex regional pain syndrome or reflex sympathetic dystrophy of upper limb<ref name=":0">[https://onlinelibrary.wiley.com/doi/full/10.1002/pri.1902 Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial]</ref>. Shoulder-hand Syndrome (SHS) is a multifactorial disorder<ref name=":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.</ref>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<ref name=":2">[https://www.frontiersin.org/articles/10.3389/fneur.2019.00433/full Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis]</ref><ref name=":3">[https://journals.sagepub.com/doi/full/10.1177/0269215511432355?casa_token=cYzPfyqVvbQAAAAA%3AipgyKXBqUmls2tURHIiJTAMz4EAXX1kSI56xZIsqItd-Rsyb6KwdIuv5kCG4Q1ikraaXlHgFMEOr Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post-hemiplegic shoulder–hand syndrome: a randomized clinical trial]</ref>.The cause is still unknown, but it may be due to one or multiple causes which include<ref name=":1" />:<ref name=":4">[https://d1wqtxts1xzle7.cloudfront.net/42079037/Systematic_review_of_aetiology_and_treat20160204-30232-1wm564w-with-cover-page-v2.pdf?Expires=1650801804&Signature=NPuStHKJGl84SQz6jT1GKT-qeLpC5n7EZkgCNpy5NTChRTYAdHu3kitrKHkqDM3QvgfETcceOyMutdFh4WBQMzbwBRaS1eEDCQI2dRxZUTaB8HKFP9EiDmKzRc8aK279aJARc4lDA2bkXO3TTNnUesyZFEKUwk~C5PayrcYZn9WJ8eZ68dWIbOHeaJOisHWf1GcxWj3X~w75nvUBDDoThiFCqukykRP27UJJZUOE56zpOze4nrMHfhiD-I2D-fP3QIfnJ8BWIMzjLUX7AFZqE-EQ-JCbP5jL-~voqSO3gGmxtLYLaKZybEselG97OFj2Lu-IqK~-2k532P-NAzivbA__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome]</ref>
 
== Symptoms and Diagnosis ==
[[File:Screenshot (1).png|left|thumb|[https://d1wqtxts1xzle7.cloudfront.net/42079037/Systematic_review_of_aetiology_and_treat20160204-30232-1wm564w-with-cover-page-v2.pdf?Expires=1650801804&Signature=NPuStHKJGl84SQz6jT1GKT-qeLpC5n7EZkgCNpy5NTChRTYAdHu3kitrKHkqDM3QvgfETcceOyMutdFh4WBQMzbwBRaS1eEDCQI2dRxZUTaB8HKFP9EiDmKzRc8aK279aJARc4lDA2bkXO3TTNnUesyZFEKUwk~C5PayrcYZn9WJ8eZ68dWIbOHeaJOisHWf1GcxWj3X~w75nvUBDDoThiFCqukykRP27UJJZUOE56zpOze4nrMHfhiD-I2D-fP3QIfnJ8BWIMzjLUX7AFZqE-EQ-JCbP5jL-~voqSO3gGmxtLYLaKZybEselG97OFj2Lu-IqK~-2k532P-NAzivbA__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome]]]


# Prolonged immobility.


# Repeated minor trauma from blood drawing and intravenous injections.
# Angio-spasm
# Perceptual deficit
# Central sympathetic dysregulation and neurogenic inflammatory reactions


== Symptoms and Signs<ref name=":4" /> ==
{| class="wikitable"
|+
!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
|}


== Treatment ==
== Treatment ==
The Treatment is Multidisciplinary approach that include :


== Resources  ==
* Medication<ref name=":4" /><ref name=":0" />: NSAID, Oral Corticosteroid, Shoulder Steroid Injection.
*bulleted list
* Physical Therapy which includes:
*x
or


#numbered list
# Mirror Therapy<ref name=":4" /><ref name=":0" />
#x
# Orthosis<ref name=":3" />
# Acupuncture<ref>[https://journals.sagepub.com/doi/full/10.1177/0269215517729528?casa_token=rT8OlmHpGcoAAAAA%3ACdBd07incvauc4CKc3s7RfTQWC5vo_1B_hWF-jxS4NzXvaZE2irZZIYtLxuXM7usThuqDFWyEMyp Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis]</ref><ref name=":2" />
# Passive and Active R.O.M.<ref name=":4" />
# Laser<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645550/ LASER THERAPY OF PAINFUL SHOULDER AND SHOULDER-HAND SYNDROME IN TREATMENT OF PATIENTS AFTER THE STROKE]</ref>
# T.E.N.S.<ref name=":4" />


== References  ==
== References  ==


<references />
<references />

Revision as of 19:32, 24 April 2022

Original Editor - User Name

Top Contributors - Essam Ahmed  

Definition and Causes[edit | edit source]

Also known as Poststroke 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[5][edit | edit source]

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

Treatment[edit | edit source]

The Treatment is Multidisciplinary approach that include :

  • Medication[5][1]: NSAID, Oral Corticosteroid, Shoulder Steroid Injection.
  • Physical Therapy which includes:
  1. Mirror Therapy[5][1]
  2. Orthosis[4]
  3. Acupuncture[6][3]
  4. Passive and Active R.O.M.[5]
  5. Laser[7]
  6. T.E.N.S.[5]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial
  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 Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis
  4. ↑ 4.0 4.1 Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post-hemiplegic shoulder–hand syndrome: a randomized clinical trial
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome
  6. ↑ Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis
  7. ↑ LASER THERAPY OF PAINFUL SHOULDER AND SHOULDER-HAND SYNDROME IN TREATMENT OF PATIENTS AFTER THE STROKE
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