Shoulder-Hand Syndrome in Hemiplegic Patients: Temperature,Sympathetic Skin Responses,and Nerve Latencies of the Affected and Nonaffected Upper Extremity
Free accessResearch articleFirst published online December, 1995
Shoulder-Hand Syndrome in Hemiplegic Patients: Temperature,Sympathetic Skin Responses,and Nerve Latencies of the Affected and Nonaffected Upper Extremity
Shoulder-hand syndrome (SHS) is a frequent complication in stroke rehabilitation. Its etiology is not completely understood. We studied twenty-one hemiparetic patients with and eighteen patients without SHS. Variables were palm temperature, sympathetic skin responses (SSR), and proximal nerve latencies of both the affected and nonaffected upper extremity. In patients with SHS, the paretic extremity was significantly warmer and showed enhanced SSR responses when stimulated on the affected side and prolonged proximal nerve latencies in comparison to the nonaffected side. There was no difference in these parameters between both sides in patients without SHS. The altered tonic and reflex mediated sympathetic responses in patients with SHS may be related to neuroapraxia of the axillary plexus due to malalignment of the hemiplegic shoulder. Therapeutic consequences are discussed based on the pathomechanism. Key Words: Hemiparesis—Rehabilitation—Shoulder-hand syndrome.
References
1.
Steinbrocker O.Shoulder-hand syndrome: associated painful homolateral disability of shoulder and hand with swelling and atrophy of the hand. Am J Med1947:3:402-407.
2.
Davis SW, Petrillo CR, Eichberg RD, Chu DSShoulder-hand syndrome in a hemiplegic population: a 5-year retrospective study. Arch Phys Med Rehabil1977;58:353-56.
3.
Braus DF, Krauss JK, Strobel J.The shoulder-hand syndrome after stroke: a prospective clinical trial . Ann Neurol1994;36:728-33.
4.
Kozin F., Ryan LM, Carrera GF, Soin JS, Wortman RLThe reflex sympathetic dystrophy syndrome (RSDS): III scintigraphic studies, further evidence for the therapeutic efficacy of systemic corticosteroids, and proposed diagnostic criteria. Am J Med1981; 70:23-30.
Tepperman PS , Greyson ND, Hilbert L., Jimenez J., Williams JIReflex sympathetic dystrophy in hemiplegia . Arch Phys Med Rehabil1984;65:442-47.
7.
Bohannon RW, Larkin PA, Smith MB, Horton MGShoulder pain in hemiplegia: statistical relationship with five variables . Arch Phys Med Rehabil1986;67:514-16.
8.
Van Ouwenaller C, Laplace PM, Chantraine A.Painful shoulder in hemiplegia. Arch Phys Med Rehabil1986;67:23-26.
9.
Joant RLThe source of shoulder pain. Arch Phys Med Rehabil1992;73:409-13.
10.
Faghri PD, Rodgers MM, Glaser RM, Bors JG, Ho C., Akuthota P.The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil1994;75:73-79.
11.
Brooke MM, de Lateur BJ, Diana-Rigby GC, Questad KAShoulder subluxation in hemiplegia: effects of three different supports . Arch Phys Med Rehabil1991;72:582-86.
12.
Leandri M., Parodi CI, Corrieri N., Rigardo S.Comparisons of TENS treatments in hemiplegic shoulder pain. Scand J Rehab Med1990;22:69-71.
13.
Hecht JSSubscapular nerve block in the painful hemiplegic shoulder. Arch Phys Med Rehabil1992;73:1036-39.
14.
Uncini A., Pullman SL, Lovelace RE, Gambi D.The sympathetic skin response: normal values, elucidation of afferent components and application limits. J Neurol Sci1988;87:299-306.
15.
Elie B., Guiheneuc P.Sympathetic skin response: normal results in different experimental conditions . Electroenceph Clin Neurophysiol1990;76:258-67.
16.
Bernthal PJ , Koss MCSome physiologic characteristics of the electrodermal reflex in the cat. Brain Res Bull1978;3:437-41.
17.
Isamat F.Galvanic skin responses from stimulation of limbic cortex. J Neurophysiol1961;24:176-81.
18.
Subarro J., Stillwell GKReflex sympathetic dystrophy syndrome of the upper extremity: analysis of total outcome of management of 125 cases. Arch Phys Med Rehabil1981;62:549-54.
