shoulder-hand syndrome
Introduction
Introduction to shoulder-hand syndrome Shoulder-hand syndrome (Shoulder-handsyndrome) was first reported by Morehead and Keen in 1864, usually associated with upper limb trauma. However, there are also those who have no history of trauma in the upper limbs. These patients may be associated with heart disease, rheumatoid arthritis or brain damage, and mental illness. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: rheumatoid arthritis
Cause
Cause of shoulder-hand syndrome
Cause:
The pathogenesis of this disease is still unclear. The currently recognized mechanism is that the acute attack of cerebrovascular disease affects the vasomotor center in front of the motor center, vasomotor nerve palsy, and causes sympathetic excitability and vasospasm in the affected limb, peripheral blood. Increased flow, local tissue dystrophies, resulting in edema, pain, pain stimulation and further through the peripheral sensory nerves to the spinal cord, triggering abnormal excitatory stimulation of the spinal nerves, causing a vicious circle of vascular motility abnormalities.
Prevention
Shoulder-hand syndrome prevention
The prevention of shoulder-hand syndrome is very important. Once it occurs, it will not only bring pain to the patient, but also seriously affect the recovery of upper limb function. The main prevention of this disease is as follows:
(1) Placement of the good limb position: It is required to avoid the flexion of the wrist joint in any position, and ensure that the wrist joint is as far as possible in the back extension position. For example, in the supine position, the upper limb of the affected side is properly abducted and externally rotated to avoid the upper limb. When the affected side is in the lower lying position, the upper limb of the affected side is stretched forward, and the palm of the hand is slightly extended to the wrist. When the lateral side is placed, a soft pillow is placed on the chest, and the upper limb of the affected side is placed on the upper side, paying attention to the wrist. Keep the back of the wrist joint. When sitting on the bed or sitting in a wheelchair, always keep the affected upper limb on the front table. You can place a soft pillow under the arm to prevent the wrist from flexing. Let the upper limb of the affected side hang over the wheelchair.
(2) Avoid excessive pulling: Passive active joints should vary from person to person, and excessive passive movement of the affected hand may cause damage to the joint and its surrounding structures.
(3) Application of shoulder strap : Shoulder strap should be applied properly in the early stage to prevent dislocation of the shoulder joint, and excessive pulling of the shoulder joint should be prevented.
(4) Exercise therapy: the active and passive exercise of the hand, the therapist does passive activities on the joint, or the patient himself uses the hand to hold the hand to do the upper leg movement of the affected side and the flexion and extension of the wrist and wrist joint. Preventing joint movement limitation and facilitating blood return of the affected limb.
(5) Other adjuvant therapies .
Complication
Shoulder-hand syndrome complications Complications rheumatoid arthritis
If the disease is not interfered, the deformity of the hand will be complicated in the late stage, and it is typical. Although there is no edema and pain, the joint activity will be permanently lost, and the wrist and interphalangeal joint activities are obviously restricted. After the restriction, the palm flattened, the size of the fish muscle atrophy, so the prevention of shoulder-hand syndrome is very important, once it occurs not only pain, but also seriously affect the recovery of upper limb function.
Symptom
Shoulder-hand syndrome symptoms Common symptoms Shoulder joint activity restricted hand acid shoulder pain Muscle atrophy Nutrition disorder Osteoporosis hand and finger fullness
Shoulder-hand syndrome is a common complication after stroke. Patients often have shoulder and hand swelling and pain, limited mobility or skin color changes. In the early stage, the hand often shows swelling and obvious movement limitation. The fingers become thicker, the skin lines disappear, the skin is pink or purple, and the joint movement is limited by the hand passive rotation, the wrist extension is limited, the joint between the fingers is limited when the flexion is flexed, and the pain can be caused by passive movement. .
According to the evolution of the disease, it is divided into three phases:
Stage I: acute phase, shoulder pain, limited mobility, often accompanied by finger and wrist pain; most of the fingers maintain a slight flexion position, and the range of flexion is limited; the hand is swollen, the skin is flushed, and the skin temperature increases. Higher vascular motility changes; wrist joint activity, especially during flexion, increased pain; X-ray films showed focal decalcification of the shoulder and hand bones.
Stage II: dystrophic period, shoulder and hand pain, swelling, persistent or reduced activity limitation, thin skin on hands and upper limbs, decreased skin temperature; small hand muscles atrophy, palm fascia hypertrophy.
Stage III: The pain of the shoulder and hand is relieved or disappeared, the movement of the hand vasculature disappears, and the muscle atrophy is obvious, forming a contracture deformity; X-ray films show extensive osteoporosis of the affected limb, but the atypical form can only be expressed as A certain period or part of the distal or proximal part of the affected limb.
Examine
Shoulder-hand syndrome check
The disease is mainly a detailed physical examination, the performance of physical examination in different periods is different:
Early: shoulder and hand pain are the main manifestations. It is especially obvious during passive exercise. It may have limited activity, swelling of the skin, and often feel the wrist twisting and dorsiflexion.
Mid-term: In this period, the shoulder, hand pain, swelling disappeared, skin muscles gradually shrink, and joint activity is limited.
Late: Also known as the sequelae, this period of skin muscle atrophy is more obvious, joint activity is completely restricted, and even contracture deformity, loss of function.
Diagnosis
Diagnosis of shoulder-hand syndrome
This disease is one of the common complications of stroke. The diagnosis is not difficult. It can be diagnosed according to the clinical manifestations and its characteristic progression, without identification.
