Shoulder-Hand Syndrome

Shoulder-hand syndrome is a type of reflex sympathetic dystrophy (see Section 6, Chapter 78) characterized by pain and limited motion of the shoulder and hand of the affected arm.

Causes include injury (such as falling on the hand, breaking the wrist bone [Colles' fracture]), heart attack, stroke, and possibly use of certain drugs (such as barbiturates). The precise way that shoulder-hand syndrome develops is not known, although some people seem more likely to develop the disorder than others.

Symptoms occur in three stages: stage 1 begins with sudden onset of widespread swelling (edema) and tenderness of the top of the hand and paleness of the hand due to narrowing (constriction) of the blood vessels in the hand. Pain in the shoulder and hand occurs, especially during movement. X-rays of the hands commonly show patchy areas of bone loss (osteoporosis (see Section 5, Chapter 60)). Stage 2 is characterized by a reduction in the swelling and tenderness; hand pain is less severe. Stage 3 is characterized by the disappearance of swelling, tenderness, and pain, but hand motion is limited because the fingers may be stiff or clawlike, resembling Dupuytren's contractures. X-rays at this stage often show a widespread loss in the density of bones.

Causes should be treated or eliminated. Permanent curling in of the fingers can usually be prevented with hand exercises if the disorder is diagnosed and treated early enough. Repeated injections of a local anesthetic to block the sympathetic nerves are also usually needed. This approach usually relieves pain, permitting the person to resume normal activity, but repeated injections over weeks or months may be required. Alternatively, high doses of corticosteroids taken by mouth may help. This approach is only recommended by some doctors for short durations, because long-term use of corticosteroids can cause serious and potentially permanent problems (see Section 5, Chapter 67).