Shoulder-hand syndrome was first reported by Morehead and Keen in 1864. It typically occurs following trauma to the upper limb. However, some patients develop the condition without a history of trauma, and these individuals may have associated conditions such as heart disease, rheumatoid arthritis, brain injury, or psychiatric disorders.

bubble_chart Etiology

The cause of the disease is unclear. Some believe it is due to autonomic nervous system dysfunction leading to changes in vasomotor mechanisms, while others suggest that certain disease conditions alter limb blood circulation, causing edema in the tissues of the hands and shoulders, thereby triggering the condition.

bubble_chart Clinical Manifestations

The clinical manifestations include both the shoulder and hand. The disease course is divided into three stages: the first stage lasts 3 to 6 months. After an injury or illness in the upper limb, the patient experiences a burning discomfort in the shoulder, followed by swelling and pain in the hand and fingers. Sometimes, only hand symptoms appear without any shoulder changes. The upper limb often remains in a drooping position. As the condition progresses, the shoulder's range of motion gradually decreases, finger flexion becomes restricted and painful, and passive movement of the hand and fingers causes pain. Osteoporosis occurs in the hand and wrist bones. The second stage lasts 3 to 6 months. The shoulder joint becomes painlessly fixed, while swelling in the hand and fingers lessens, but finger pain intensifies, and finger movement becomes further restricted. The skin of the hand and fingers becomes smooth, indicating trophic disturbances. The palmar fascia may contract and thicken, resembling Dupuytren's contracture. A hallmark of this disease is severe tenderness along nerve distributions and injury areas. Patients experience hand swelling, sensory disturbances, burning sensations in the upper limb, stiffness, sweating, coldness, or fever. The third stage occurs after one year of illness. The patient loses upper limb function, and the shoulder and hand become stiff and deformed. The skin atrophies and thins. The shoulder and hand are no longer painful. Hand deformities depend on changes in the intrinsic hand muscles and flexor-extensor muscles. This condition is most common in women aged 40 to 50.

Including controlling the progression of the disease, actively engaging in functional exercises, and preventing or reducing deformities. Administer anti-inflammatory drugs such as phenylbutazone derivatives and perform repeated stellate ganglion blocks in the neck. Dynamic finger splints help prevent deformities and restore finger and hand muscle strength. The use of corticosteroids, especially in the early stages of the disease, not only alleviates pain but also controls disease progression and improves prognosis. For patients with emotional instability or depression, promote mental and physical well-being, appropriately use Valium and Librium, avoid long-term use of narcotics and sedatives, and consult a psychiatrist for assistance in treatment. Pain relief, functional exercises, and stellate ganglion blocks (0.5–1% sylocain) all aid in the recovery of reflex sympathetic dystrophy. Vasodilators may also be used.