Shoulder-hand syndrome after cerebral infarction? Don’t be afraid, musculoskeletal ultrasound can help!

Author: Wang Xiaolei, Chief Physician, Affiliated Hospital of Inner Mongolia Medical University

Reviewer: Li Chunyang Chief Physician, Inner Mongolia Autonomous Region Brain Hospital (Third Hospital)

1. First experience with shoulder-hand syndrome

A stroke last year made Lao Wang's right upper limb very inconvenient to move, and new troubles have come to him recently. First, his right shoulder began to ache dully, and then the pain became more and more severe, as if countless needles were pricking him. At the same time, his hands also joined in the fun, becoming swollen, and his fingers were as thick as small carrots, and making a fist became a luxury. When he was getting dressed, he grimaced in pain at the slightest movement of his arm; when he wanted to take a sip of water from a cup, his hand was powerless and the cup almost fell to the ground. Moreover, the joint movement was restricted, and the shoulder joint was like a big lock. If he stretched it out a little or rotated it, he grimaced in pain. He wanted to lift his arm up, but he couldn't lift it high, as if there was a mysterious force pulling it down. When doing some simple movements, such as buttoning and holding chopsticks, it became extremely difficult, and every movement had to endure great pain. Lao Wang had no choice but to go to the orthopedic department for help, and the doctor diagnosed him with shoulder-hand syndrome.

Figure 1 Original copyright image, no permission to reprint

2. What is shoulder-hand syndrome?

Shoulder-hand syndrome, in simple terms, is a syndrome in which a series of symptoms occur in the patient's shoulder and hand after a stroke or other disease. It is like a "troublemaker" that often interferes with the patient's recovery, and its pathogenesis is relatively complex. Among patients with stroke, approximately 12.5%-70% of patients may experience this condition.

This is simply a "disaster" for patients. First of all, it has a huge impact on limb function. Just like Lao Wang, after rehabilitation training for cerebral infarction, his limb function was slowly recovering, but when shoulder-hand syndrome came, the movement of the shoulder joint was restricted, the hand muscles atrophied, and the fingers could not move flexibly. The previous efforts were greatly reduced, which seriously affected the normal movement ability of the limbs.

The quality of life also plummeted. Patients who were originally able to dress, eat, and wash themselves have found these simple daily activities difficult because of shoulder-hand syndrome. They want to put on clothes by themselves, but because of shoulder pain and hand weakness, they can't put them on for a long time; when eating, they can't hold chopsticks steadily and the food is spilled everywhere. These seemingly ordinary little things have become extremely difficult because of shoulder-hand syndrome, making the patients' lives full of helplessness and pain.

Exploring the causes of shoulder-hand syndrome. There is still no clear conclusion as to why shoulder-hand syndrome occurs. One theory is that after a cerebral infarction damages the central nervous system, the nerves in the shoulder and hand are affected, and vascular motor dysfunction causes local tissues to begin to have an inflammatory response, followed by symptoms such as pain and swelling, and shoulder-hand syndrome "appears on the stage". In addition, sympathetic nervous system dysfunction, shoulder trauma, prolonged inappropriate posture, and even psychological factors may induce shoulder-hand syndrome.

3. The magical musculoskeletal ultrasound appears

The orthopedic surgeon suggested that Lao Wang check the shoulder joint ultrasound and consider interventional treatment under ultrasound guidance of the joint cavity and around the joint. It was the first time that Lao Wang heard that the joints could be ultrasounded, and he couldn't help but widen his eyes. The doctor explained that early ultrasound was indeed mainly used for obstetrics and gynecology and abdominal examinations. But with the advancement of technology, people have discovered that ultrasound also has great potential in observing the musculoskeletal system. Simply put, musculoskeletal ultrasound uses the reflection of high-frequency ultrasound to "take pictures" of soft tissues such as muscles, bones, and joints. Doctors can see the appearance of structures such as muscles, tendons, ligaments, and nerves on the ultrasound machine screen, and they can see at a glance whether there are lesions and injuries. For example, muscle strains, fractures, joint injuries, ligament calcification, meniscus ruptures, synovial hyperplasia, rotator cuff tears, nerve compression, etc., cannot escape its "eagle eyes and golden eyes."

Figure 2 Original copyright image, no permission to reprint

At the doctor's suggestion, Lao Wang nervously underwent a musculoskeletal ultrasound examination. The whole process was completely painless, and he felt relieved. After the examination, the doctor told Lao Wang that the musculoskeletal ultrasound examination found that his left supraspinatus tendon was significantly swollen, the echo was reduced, and the subacromial bursa was slightly thickened, all of which were highly suggestive of shoulder-hand syndrome. Fortunately, there was not much fluid accumulation in the shoulder joint, so ultrasound interventional treatment was not required. Rehabilitation and physical therapy were recommended for the time being.

The first is physical therapy, which is like a "comprehensive care" for Lao Wang's shoulders and hands. And exercise therapy is indispensable. The rehabilitation therapist guides Lao Wang to do some simple and effective exercises. For example, let him sit on a chair and slowly perform shoulder abduction, adduction, rotation and other movements, just like applying some lubricating oil to a rusty machine to make the joints move more smoothly. The hands are exercised such as fisting and stretching to help restore the strength and flexibility of the hands. These exercises should be done step by step, and you can't rush for success, just like building a house, you have to build it up steadily layer by layer.

In addition, the doctor also coordinated some medications based on Lao Wang's specific situation to help reduce inflammation and pain. The entire treatment plan is like a closely coordinated team, with each link playing an important role and working together for Lao Wang's recovery. After a period of treatment, Lao Wang clearly felt that his symptoms had improved significantly. The pain in his shoulder was much relieved, and he was no longer restless in pain like before, and he could sleep well at night.

At the end of the treatment, the doctor especially reminded Lao Wang's family that some family members tend to use too much force when helping patients move their limbs, which can easily damage the muscles, ligaments and other tissues of the shoulders and hands, thereby inducing shoulder-hand syndrome. Therefore, whether it is passive activity or active training, the principle of gradual progress must be followed, the movements must be gentle, and the amplitude must be moderate.