THE SHOULDER-HAND SYNDROME IN REFLEX DYSTROPHY OF THE UPPER EXTREMITY

Abstract

A series of 42 cases with reflex neurovascular phenomena in the upper extremity is presented. The symptoms consisted largely of painful disability of the shoulder with homolateral pain and swelling of the hand. In most of the cases the symptoms followed some medical condition such as myocardial infarction, herpes zoster, cerebral hemorrhage, or vasculitis. In a few cases trauma was the etiologic factor, but in the largest group there was no demonstrable cause, the "idiopathic" variety. These seemingly different conditions have been described in the medical and surgical literature as separate entities, such as Sudeck''s atrophy, causalgia, the swollen atrophic hand with osteoarthritis of the cervical spine, post-infarctional sclerodactylia, painful stiffening of the shoulder after coronary occlusion, and others. The variable clinical features and the differences in severity of symptoms probably are due to different degrees of reflex neurovascular and motor reaction. Spontaneous recovery may occur in mild cases. Treatment by sympathetic interruption with sympathetic block or surgery is effective in a great number of all etiologic varieties, thus confirming the common identity of the underlying disturbance of the neurophysiologic mechanism. Results depend on the stage of the disorder.