shoulder hand syndrome physiotherapy.pptx

shoulder hand syndrome physiotherapy.pptx

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  Shoulder Hand Syndrome Dr. SatyenBhattacharyya Associate Professor: BIMLS, Bardhaman Chief Physiotherapist: Fit O Fine www.fitofine.com
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  Definition • Also knownas Post-stroke complex regional pain syndrome or reflex sympathetic dystrophy of upper limb . Shoulder-hand Syndrome (SHS) is a multifactorial disorder characterized by edema and swelling of the hand, hyperalgesia, sever pain and loss of function in the shoulder joint with changes in the skin color and temperature . The cause is still unknown, but it may be due to one or multiple causes which include
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  Causes Prolonged immobility. Repeated minortrauma from blood drawing and intravenous injections. Angio-spasm Perceptual deficit Central sympathetic dysregulation and neurogenic inflammatory reactions
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  Types Type 1 doesnot involve a direct injury to a nerve and typically occurs after an illness or other injury. Type 2 follows a distinct nerve injury.
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  Stage I: Acute StageI may last up to 3 months. Burning pain and increased sensitivity to touch are the most common early symptoms of CRPS. This pain is different — more constant and longer lasting — than would be expected with a given injury. Swelling and joint stiffness usually follow, along with increased warmth and redness in the affected limb. There may be faster-than-normal nail and hair growth and excessive sweating.
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  Stage II: Dystrophic Stage IIcan last 3 to 12 months. Swelling is more constant and skin wrinkles disappear. Skin temperature becomes cooler. Fingernails become brittle. Pain is more widespread. Stiffness increases. The affected area becomes more sensitive to touch.
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  Stage III: Atrophic Stage IIIoccurs after 1 year. The skin of the affected area becomes pale, dry, tightly stretched, and shiny. The area is stiff and there is less hope of getting motion back. Pain may decrease. The condition may spread to other areas of the body.
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  Symptoms and Signs • Shoulder-Loss of ROM; pain and tenderness elicited by these motions or in rest • Elbow- Usually no symptoms • Wrist -Considerable pain on extension; tenderness to deep palpation and dorsal oedema over carpal bones • Hand-little pain or tenderness; oedema overlying metacarpals • Digits-Considerable pain on flexion of metacarpal- phalangeal and interphalangeal joints; moderate oedema and loss of dorsal skin lines; changes in hair and nail growth; vasomotor and changes in temperature, colour and hidrosis
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  Clinical Feature • Pain: Occurringin one or more extremities is described as severe, constant, burning and/or deep aching pain. • All tactile stimulation of the skin (e.g. wearing clothing, a light breeze) may be perceived as painful (allodynia). • Paroxysmal dysaesthesias and lancinating pains. • Skin changes: Skin may appear shiny (dystrophy-atrophy), dry or scaly. • Hair may initially grow coarse and then thin. Nails in the affected extremity may be more brittle, grow faster and then slower. • Rashes, Ulcers and Pustules. • Abnormal sympathetic (vasomotor changes) activity may be associated with skin that is either warm or cold to touch. • Increased sweating (sudomotor changes) or increased chilling of the skin with goose flesh (pilomotor changes). • Swelling: • Movement disorder: • May develop dystonia. • Tremors and involuntary jerking of extremities may be present. • Disuse atrophy sets in natural history. • Spreading symptoms
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  Conservative • Medications: Non-steroidalanti-inflammatory drugs (NSAIDs), oral corticosteroids, anti-depressants, blood pressure medications, anti-convulsants and opioid analgesics are medications recommended to relieve symptoms. • Injection therapy: Injecting an anesthetic near the affected sympathetic nerves can reduce symptoms. This is usually recommended early in the course of shoulder-hand syndrome in order to arrest further progression to the later stages. • Biofeedback: Increased body awareness and relaxation techniques may help with pain relief.
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  Surgical • Spinal cordstimulator: Tiny electrodes are implanted along your spine and deliver mild electric impulses to the affected nerves. • Pain pump implantation: A small device that delivers pain medication to the spinal cord is implanted near the abdomen.
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  Physiotherapy • Mirror Therapy- •It is effective in improving sensory-motor function and reducing pain and edema in the upper limb in post-stroke patient. • Orthoses- A functional shoulder orthoses helps prevent and shoulder subluxation in post- stroke patients and reduces the risk of shoulder-hand syndrome. • Acupuncture- Combined with a rehabilitation program, Acupuncture helps reduce the pain, Improves upper limb function and the activity of daily living compared with rehabilitation program alone. • Passive and Active R.O.M.- Maintain R.O.M. and function of the shoulder and hand. • LASER • Effective in reducing pain and edema in the affected hand and shoulder, improves R.O.M. and Promotes Independency in post-stroke patients. • T.E.N.S.: Helps in reducing pain in the affected hand and shoulder and promote R.O.M.
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  Refrences • https://bangaloreshoulderinstitute.com/shoulder-hand-syndrome/ • https://visaliavips.com/spinal-cord-stimulator-placement •https://www.physio-pedia.com/Shoulder-hand_Syndrome# • https://orthoinfo.aaos.org/en/diseases--conditions/complex-regional-pa in-syndrome-reflex-sympathetic-dystrophy/