Shoulder-Hand Syndrome

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Shoulder-Hand Syndrome is a relatively common occurrence after stroke. Typically the person has a stroke which leaves them paralyzed on one side. Recovery of the paralysis varies between patients, but often the legs recover quicker then the upper extremity. For some unknown reason, some people are left with significant weakness in the upper extremity that can be quite painful. When the pain is severe in the hand and shoulder on the paralyzed side, the condition is known as Shoulder Hand Syndrome.


  • Shoulder Pain
  • Hand Pain
  • Numbness
  • Elbow Pain
  • Wrist Pain
  • Tingling

  • Symptoms occur in three stages:
    ....Stage 1
    begins with sudden onset of widespread swelling and tenderness of the top of the hand and paleness of the hand due to narrowing 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.
    ....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 include injuries such as falling on the hand, breaking the wrist bone, 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.

    Treatment should be started as early as possible. This may prevent the disease from progressing. Treatment usually includes a combination of therapies, such as:

  • Medications -- pain medicines, steroids, blood pressure medicines that work on the sympathetic nervous system, bone loss medications (such as Actonel), and antidepressants
  • Physical or occupational therapy
  • Applications of heat and cold
  • The use of a trancutaneous electrical nerve stimulator unit
  • Biofeedback
  • Injecting medicine to numb the affected nerves or pain fibers around the spinal column
  • Surgery that involves cutting the nerves to destroy the pain, but other sensations may be destroyed as well

  • .....

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