Shoulder Hand Syndrome

Complex regional pain syndrome of upper limbs after stroke is frequently called shoulder-hand syndrome (SHS). Complex regional pain syndrome  is  neuropathic pain disorders that develop as an exaggerated response to a traumatic lesion or nerve damage or as the consequence of a distant process such as a stroke, spinal lesion or myocardial infarction.

However, sometimes it may appear without an apparent cause.

The onset and severity of shoulder hand syndrome appears to be related with the cause of the stroke, the severity and recovery of motor deficit, spasticity and sensory disturbances.

Another important aetiological factor is glenohumeral subluxation. The physiopathology of the disease is still not known.

In CRPS, there is an exaggerated inflammatory response and some chemical mediators have been identified and are present in the inflammatory soup around the primary afferent fibres that, through different processes, can induce hyper-excitability of the afferent fibres . It is hypothesized that a localized neurogenic inflammation is at the basis of oedema, vasodilation and hyperhidrosis that are present in the initial phases of CRPS. The repeated discharge of the C fibres causes an increased medullary excitability (central sensitization). Another important factor is the reorganisation of the central nervous system, and in particular this appears to affect the primary somatosensory cortex

Diagnosis of Shoulder Hand Syndrome

There would be a hisotry of stroke and the paretic upper arm frequently appears painful, swollen, with altered heat and tactile sensations and slightly dystrophic skin within a non-use syndrome.

Diagnosis is clinical and there are no specific tests, nor pathognomic symptoms to identify this disease with certainty.

Imaging in Shoulder Hand Syndrome

Imaging is non contributory. However, some investigations can aid differential diagnosis with other diseases.

Treatment of Shoulder Hand Syndrome

Treatment may be consists of  psychotherapy, regional anaesthesia, neuromodulation and sympathectomy.

A variety of drugs are used to treat shoulder hand syndrome which include antidepressants, anti-inflammatory drugs,  vasodilators, GABA analogs such gabapentin and pregabalin, and alpha- or beta-blockers, and  opoid analgesics.

The key to effective treatment undoubtedly lies in a an expert multidisciplinary team.