Shoulder-hand syndrome

　　The pathogenesis of this disease is not yet clear. The mechanism currently widely recognized is that the acute onset of cerebrovascular disease affects the vasomotor center in front of the motor center, leading to vasomotor neuritis, increased sympathetic excitability of the affected limb, and vasoconstriction response. This results in increased peripheral blood flow, causing local tissue nutritional disorders. Consequently, edema and pain occur, and the pain stimulus further transmits through the peripheral sensory nerves to the spinal cord, triggering abnormal excitability stimulation of the intermediate spinal nerve, leading to a恶性循环 of abnormal vasomotor function.

　　If the disease is not intervened, late complications such as deformities of the hand will occur, and they are typical. Although there is no edema and pain, the permanent loss of joint activity will occur. The movement of the wrist joint, metacarpophalangeal joint is obviously limited, the supination of the forearm is limited, the palm becomes flat, the thenar and hypothenar muscles atrophy, so 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.

　　Divided into three stages according to the evolution of the disease:

　　1. I stage:Acute stage, shoulder pain, 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, increased skin temperature and other vascular motor changes; wrist joint pain increases especially during flexion; X-ray films often show focal decalcification of the shoulder and hand bones.

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

　　3. III stage:The pain of the shoulder and hand decreases or disappears, the vascular motor changes of the hand disappear, but the muscle atrophy is obvious, forming contracture deformities; X-ray films show that the affected limb has extensive osteoporosis, but the atypical form can also only manifest as one or part of the affected limb. The distal or proximal part.

　　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 this disease are mainly as follows:

　　1. Positioning of good limb positions:It is required to avoid wrist flexion at all body positions, ensuring that the wrist joint is as much as possible in a plantar flexed position. For example: in the supine position, the affected upper limb should be appropriately abducted and externally rotated to avoid pressure on the upper limb. When the affected side is in a prone position, the affected upper limb should be extended forward with the palm up, the wrist slightly plantar flexed. 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 prop up the wrist, and keep the wrist in a plantar flexed position. When sitting, whether sitting on a bed or in a wheelchair, always keep the affected upper limb on the front table. A soft pillow can be placed under the arm to prevent wrist flexion, and the affected upper limb should never hang outside the wheelchair.

　　2. Avoid excessive stretching:Passive joint movement should vary from person to person, as excessive passive movement of the affected hand may cause injury to the joint and 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:Active and passive movements of the affected hand, passive joint movements by the therapist, or the patient using the healthy hand to hold the affected hand for the upward movement of the upper limb and the flexion and extension movements of the finger and wrist joints can prevent the occurrence of joint restriction in movement and is conducive to the blood return of the affected limb.

　　5. Other auxiliary therapies.

　　This disease mainly involves a detailed physical examination, and the manifestations of the physical examination are different at different stages:

　　1. Early stage:The main manifestation is pain in the shoulder and hand, which is more obvious during passive movement. There may be restricted movement, swelling of the skin, and often a feeling of difficulty in supination and extension of the wrist.

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

　　3. Late stage:Also known as the post-effect period, during this period, the atrophy of the skin and muscles is more obvious, the joint activity is completely restricted, and even contractures and deformities occur, resulting in the loss of function.

　　Dietary Care:

　　During the acute phase, semi-liquid or fluid foods should be given; during the recovery period, more meat, eggs, fish, beans, fruits, and vegetables can be eaten. Foods that are difficult to digest, such as raw, cold, and hard foods, should be avoided to prevent damage to the spleen.

　　Patients with this disease should be given anti-inflammatory drugs such as phenylbutazone derivatives and repeated cervical ganglion blockade. Finger dynamic splints are helpful in preventing deformities and restoring finger and hand muscle strength. The use of corticosteroids, especially in the early stage of the disease, not only relieves pain but also controls the progression of the disease and improves the prognosis of the disease. For patients with unstable emotions and depression, it is necessary to guide physical and mental health, appropriately use valium and librium, and avoid long-term use of anesthetics and sedatives. Please consult a psychiatrist for assistance in treatment. Analgesics, functional exercises, and cervical ganglion blockade (0.5% to 1% xylocaine) are all helpful for the recovery of reflex sympathetic dystrophy. Vasodilators can also be used..