Complex regional pain syndrome

　　Complex regional pain syndrome (RSD) refers to sudden swelling and pain in the affected hand and shoulder joint pain, which also limits hand function. The etiology of this disease is not yet clear and may be related to the following factors:

　　1, It is currently believed that regardless of the cause, it affects the autonomic sympathetic nervous system, causing peripheral nerve and vascular disorders.

　　2, Potential other factors include associated joint degeneration, minor shoulder joint injuries, disuse atrophy caused by long-term inactivity, and abnormal vascular nerve reflexes.

　　What complications can shoulder-hand syndrome easily lead to?

　　What are the typical symptoms of shoulder-hand syndrome?

　　The shoulder-hand syndrome is a common complication after a stroke. It often appears with swelling, pain, limited activity, or skin color changes in the shoulder joint and hand of patients. In the early stage, it often manifests as swelling of the affected hand, with obvious movement limitation, fingers becoming thicker, skin lines disappearing, and the skin showing pink or purple. The limitation of joint activity is manifested as passive supination of the hand, limitation of wrist extension, and limitation of flexion of interphalangeal joints when the hand is extended; passive activity can cause pain.

　　I stage:Acute stage, shoulder pain and limited activity, often accompanied by pain in the fingers and wrist joints; most fingers maintain a slight flexed position, and the range of motion of flexion is limited; hand swelling, skin redness, and increased skin temperature and other vascular motor changes; wrist joint activity, especially flexion, becomes more painful; X-ray films often show focal decalcification of the shoulder-hand bones.

　　II stage:Nutritional disorder stage, the symptoms of shoulder-hand pain, swelling, and limited activity persist or decrease, the skin of the hand and upper limb is thin, and the skin temperature is reduced; the small muscles of the hand are obviously atrophied, and the palmar fascia is thickened.

　　III stage:The pain of the shoulder and hand decreases or disappears, the vascular motor changes of the hand disappear, while muscle atrophy is obvious, forming contracture deformity; X-ray films show extensive osteoporosis of the affected limb. But atypical forms can also only manifest as one or part of the affected limb.

　　The prevention of shoulder-hand syndrome is quite important. Once it occurs, it not only brings pain to the patient but also seriously affects the recovery of upper limb function. The main points for the prevention of shoulder-hand syndrome are mainly as follows:

　　1. Positioning of good limb position:It is required to avoid wrist flexion at any body position, ensuring that the wrist is as much in extension as possible. For example: in supine position, the affected upper limb should be properly abducted and externally rotated to avoid compression of the upper limb. When the affected side is in a prone position, the affected upper limb should be extended forward with the palm up and the wrist slightly extended. When lying on the healthy side, place a soft pillow in front of the chest, place the affected upper limb on top, pay attention to support the wrist, and maintain the wrist in extension. When sitting, whether sitting on a bed or in a wheelchair, always keep the affected upper limb on the front table, you can place a soft pillow under the arm to prevent wrist flexion, and never let the affected upper limb hang outside the wheelchair.

　　2. Avoid excessive stretching:Passive joint activity should vary from person to person, as excessive passive activity of the affected hand may cause injury to the joint and its surrounding structures.

　　3. Application of shoulder slings:Early application of shoulder slings is appropriate to prevent shoulder joint dislocation and to prevent excessive stretching of the shoulder joint.

　　4. Exercise Therapy:The patient's hand performs active and passive movements, the therapist performs passive joint movements, or the patient uses the healthy hand to hold the affected hand to perform the upper limb upper traction movement and the finger wrist joint flexion and extension movement to prevent joint movement limitation, which is beneficial for the blood return of the affected limb.

　　Shoulder-hand syndrome mainly involves a detailed physical examination, and the manifestations of physical examination are different in different stages:

　　Early stage:The main manifestation is pain in the shoulder and hand, especially obvious during passive movement, with limited activity and swelling of the skin. It is often felt that the supination and extension of the wrist are difficult.

　　Middle stage:During this period, the pain and swelling in the shoulder and hand disappear, the skin and muscles gradually atrophy, and the joint movement is significantly limited.

　　Late stage:Also known as the sequelae stage, during this period, the atrophy of the skin and muscles is more obvious, the joint movement is completely limited, and even contractures and deformities occur, leading to the loss of function.

　　During the acute phase of shoulder-hand syndrome, semi-liquid or liquid foods should be given; during the recovery period, more meat, eggs, fish, beans, fruits, and vegetables can be eaten. It is forbidden to eat raw, cold, hard, and indigestible foods to prevent injury to the spleen.

　　For patients with nausea and vomiting, hot ginger soup can be taken to relieve qi and stop vomiting.

　　Shoulder-hand Syndrome (RSD) refers to sudden swelling and pain in the patient's hand and shoulder joint pain, which also limits hand function. Patients with shoulder-hand syndrome should be given anti-inflammatory drugs such as phenylburazone derivatives and repeated cervical ganglion blockades. Dynamic finger splints help prevent deformities and restore the muscle strength of the fingers and hands. The use of corticosteroids, especially in the early stage of the disease, can not only alleviate pain but also control the progression of the disease and improve the prognosis of the disease. For patients with unstable emotions and depression, it is necessary to guide mental and physical health, and use valium and librium appropriately, avoiding long-term use of anesthetics and sedatives. Please consult a psychiatrist for assistance in treatment. Pain relief, functional exercise, and cervical ganglion blockades (0.5% to 1% xylocaine) are all helpful for the recovery of reflex sympathetic dystrophy. Vasodilators can also be used.