Shoulder-hand Syndrome: Difference between revisions

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== Definition and Causes ==
== Definition and Causes ==
Also known as Post-[[stroke]] [https://www.physio-pedia.com/index.php?title=Complex_Regional_Pain_Syndrome_(CRPS)&redirect=no%3Futm_source%3Dphysiopedia&utm_medium=search&utm_campaign=ongoing_internal complex regional pain syndrome] or reflex sympathetic dystrophy of upper limb<ref name=":0">Saha S, Sur M, Ray Chaudhuri G, Agarwal S. [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.] Physiotherapy Research International. 2021;26(3).</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 [https://www.physio-pedia.com/Shoulder?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal shoulder joint] with changes in the skin color and temperature<ref name=":2">[https://www.frontiersin.org/articles/10.3389/fneur.2019.00433/full 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.]</ref><ref name=":3">[https://journals.sagepub.com/doi/full/10.1177/0269215511432355?casa_token=cYzPfyqVvbQAAAAA%3AipgyKXBqUmls2tURHIiJTAMz4EAXX1kSI56xZIsqItd-Rsyb6KwdIuv5kCG4Q1ikraaXlHgFMEOr 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.]</ref>.The cause is still unknown, but it may be due to one or multiple causes which include<ref name=":1" /><ref name=":4">C. H Geurts, B. A. J. T. Visschers, A. [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.] Scandinavian Journal of Rehabilitation Medicine. 2000;32(1):4-10.</ref>
Also known as Post-[[stroke]] [https://www.physio-pedia.com/index.php?title=Complex_Regional_Pain_Syndrome_(CRPS)&redirect=no%3Futm_source%3Dphysiopedia&utm_medium=search&utm_campaign=ongoing_internal complex regional pain syndrome] or reflex sympathetic dystrophy of upper limb<ref name=":0">Saha S, Sur M, Ray Chaudhuri G, Agarwal S. [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.] Physiotherapy Research International. 2021;26(3).</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 [https://www.physio-pedia.com/Shoulder?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal shoulder joint] with changes in the skin color and temperature<ref name=":2">Liu S, Zhang C, Cai Y, Guo X, Zhang A, Xue C et al. [https://www.frontiersin.org/articles/10.3389/fneur.2019.00433/full Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis]. Frontiers in Neurology. 2019;10.</ref><ref name=":3">Hartwig M, Gelbrich G, Griewing B. [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.] Clinical Rehabilitation. 2012;26(9):807-816.</ref>.The cause is still unknown, but it may be due to one or multiple causes which include<ref name=":1" /><ref name=":4">C. H Geurts, B. A. J. T. Visschers, A. [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.] Scandinavian Journal of Rehabilitation Medicine. 2000;32(1):4-10.</ref>


# Prolonged immobility.
# Prolonged immobility.
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# [[Mirror Therapy]]<ref name=":4" /><ref name=":0" />
# [[Mirror Therapy]]<ref name=":4" /><ref name=":0" />
# [https://www.physio-pedia.com/Orthoses_for_Management_of_Neuromuscular_Impairment?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Orthoses]<ref name=":3" />
# [https://www.physio-pedia.com/Orthoses_for_Management_of_Neuromuscular_Impairment?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Orthoses]<ref name=":3" />
# [[Acupuncture]]<ref>[https://journals.sagepub.com/doi/full/10.1177/0269215517729528?casa_token=rT8OlmHpGcoAAAAA%3ACdBd07incvauc4CKc3s7RfTQWC5vo_1B_hWF-jxS4NzXvaZE2irZZIYtLxuXM7usThuqDFWyEMyp 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.]</ref><ref name=":2" />
# [[Acupuncture]]<ref>Peng L, Zhang C, Zhou L, Zuo H, He X, Niu Y. [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.] Clinical Rehabilitation. 2017;32(4):429-439.</ref><ref name=":2" />
# Passive and Active [[Range of Motion|R.O.M]].<ref name=":4" />
# Passive and Active [[Range of Motion|R.O.M]].<ref name=":4" />
# [[Low Level Laser Therapy|Laser]]<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645550/ 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.]</ref>
# [[Low Level Laser Therapy|Laser]]<ref>Karabegović A, Kapidžić-Duraković S, Ljuca F. [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.] Bosnian Journal of Basic Medical Sciences. 2009;9(1):59-65.</ref>
# [[Transcutaneous Electrical Nerve Stimulation (TENS)|T.E.N.S.]]<ref name=":4" />
# [[Transcutaneous Electrical Nerve Stimulation (TENS)|T.E.N.S.]]<ref name=":4" />


Revision as of 18:55, 28 April 2022

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

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. Orthoses[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 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 5.5 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. ↑ 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.
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