Shoulder pain, hand swelling, and numbness after a stroke? Beware of "shoulder-hand syndrome"

Many patients with hemiplegia due to stroke may feel discomfort in their upper limbs during long-term bed rest, such as prolonged shoulder pain, swollen hands, numb hands , etc. Many people just think that it is a normal condition of hemiplegia and do not deal with it for a long time. In the long run, they will find that their upper limb functions can never be restored. Experts from Liling City Traditional Chinese Medicine Hospital remind that in this case, you should be careful about shoulder-hand syndrome .

1. What is shoulder-hand syndrome?

Shoulder-hand syndrome is characterized by sudden edema and pain in the affected hand and pain in the shoulder joint, which limits the function of the hand. The patient experiences severe tenderness along the nerve distribution and the injured area, swelling of the hand, sensory impairment, burning sensation, stiffness, sweating, coldness or fever in the upper limbs.

Due to the severe pain and contracture, shoulder-hand syndrome often becomes an obstacle to recovery. It is a common complication in patients with hemiplegia after stroke. It usually affects the upper limb on the affected side, and only 1/5 of the patients can fully resume their previous activities. If not properly treated, it will lead to permanent deformities of the shoulder, hand, and fingers.

2. Why does shoulder-hand syndrome occur?

There are many causes of shoulder-hand syndrome.

1. After a stroke, the limbs are paralyzed, the shoulder and hand muscles are weakened, and the range of motion of the joints is limited. Long-term inactivity or improper activity may lead to contracture and adhesion of muscles, tendons, joint capsules and other tissues, causing pain and swelling.

2. Stroke may affect the autonomic nervous system, leading to increased sympathetic nerve excitability and causing vasoconstriction, thereby affecting blood circulation in the upper limbs and causing swelling and pain.

3. During the rehabilitation process of stroke patients, if the upper limb joints are in a flexed position for a long time or the limbs are placed in an inappropriate posture, it may compress the blood vessels and nerves in the hands, affect venous return and lymphatic circulation, and cause swelling and pain in the hands.

3. How to prevent shoulder-hand syndrome?

1. Correct body position

Maintaining the correct posture in bed in the early stage can effectively prevent and counteract the occurrence of spastic posture and protect the shoulder joint. Alternate between lying on the affected side, lying on the healthy side and lying on the back.

① Lying on the affected side: extend the affected arm forward, externally rotate the forearm, pull the affected shoulder out to avoid compression and retraction; extend the fingers, palm up, and do not hold anything in the hand to avoid inducing the grasping reflex and strengthening the flexion spasm of the affected hand.

② Lying on the healthy side: Place a soft pillow in front of the chest, fully extend the affected shoulder forward, stretch the elbow, wrist, and knuckles and place them on the pillow, with the heart facing downward.

③ Supine position (try to shorten the time in other positions): Place a thick and soft pillow under the affected shoulder to lift the shoulder to prevent the scapula from contracting posteriorly. Externally rotate the upper arm and slightly abduct it, straighten the elbow and wrist joints, with the palm facing up, fingers straight and spread apart, and the entire upper limb placed on the pillow.

④ Sitting position in bed: Place a small adjustable table across the bed, put a soft pillow on the table, and raise the affected upper limb and place it on the soft pillow. When sitting in a wheelchair, the affected upper limb should be raised.

⑤ Standing or walking: Hang the affected upper limb or wear a shoulder brace to avoid natural hanging causing shoulder dislocation or excessive traction.

2. Early rehabilitation training

After the patient's condition stabilizes, passive and active upper limb joint movements should be started as soon as possible, including flexion and extension, rotation and other exercises of the shoulder, elbow, wrist and fingers, to promote blood circulation, prevent muscle atrophy and joint stiffness, and maintain joint flexibility and range of motion.

When exercising, pay attention to the moderate range of motion, avoid excessive stretching, and avoid damage to the soft tissue around the joints.

4. How to treat shoulder-hand syndrome?

1. Exercise therapy

Active and passive movements of the affected upper limb.

① Active exercise: Bobath handshake, the patient lies on his back, crosses the fingers of both hands, places the thumb of the affected hand on the thumb of the healthy hand, uses the healthy upper limb to drive the affected upper limb to extend the elbow in front of the chest and raise it, then bend the elbow, return both hands to the chest, and repeat this process.

② Passive movement: For patients who are unable to actively move, passive movement of the shoulder joint performed by a therapist can prevent shoulder pain. Passive movement of the hands and fingers should also be very gentle and should not cause pain.

2. Occupational therapy

According to the patient's daily life needs and functional impairment, personalized work activities are designed, such as dressing, eating, washing, etc. Through repeated practice of these activities, the patient's upper limb fine motor ability and daily life self-care ability are improved.

3. Physical therapy

Ice therapy, hot compress, alternating hot and cold water, transcutaneous neuromuscular electrical stimulation, kinesio taping, pneumatic compression therapy, etc.

4. Drug therapy: non-steroidal anti-inflammatory drugs, circulation-improving drugs, etc.

5. Traditional Chinese medicine treatments: acupuncture, massage, Chinese medicine fumigation, oral Chinese medicine, etc.

Rehabilitation of shoulder-hand syndrome is a long process that requires the joint efforts of patients, family members and medical staff. Patients should maintain a positive attitude and follow the guidance of doctors and rehabilitation therapists for treatment and training; family members should give patients full care and support and assist patients in completing daily rehabilitation exercises. As long as they persevere, there is hope to alleviate symptoms, restore upper limb function and improve quality of life.

Hunan Medical Chat Special Author: Hu Xiaozhen and Xie Runzhen, Rehabilitation Department, Liling Traditional Chinese Medicine Hospital

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(Edited by YT)