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PubMed1982

A synthesis of studies on stroke rehabilitation.

The functional rehabilitation of stroke patients is a frequent service provided in hospitals and long care settings. Research regarding the effectiveness of therapy has been conducted infrequently and the results of studies often conflict. This article describes the results of seven studies which employed different study designs and sample populations. Three observational studies found that rehabilitation is effective while three experimental studies found no effect. One observational study not only failed to find a positive effect but also found that physical therapy was associated with shoulder-hand syndrome. The findings of these seven studies are synthesized in an attempt to resolve apparently conflicting results and arrive at conclusions which are consistent. The evidence suggests that functional gains experienced by stroke patients are primarily attributable to spontaneous recovery. Eighty percent of spontaneous recovery occurs within six months after the onset of stroke. Age does not appear to be an important factor in improvement although older patients tend to have more severe strokes. Socioeconomic status and family involvement correlate positively with improvement. Rehabilitation has a negligible effect on the functional progress of most stoke patients. However, rehabilitation may result in increased independence in the performance of activities of daily living for patients who have intermediate levels of functional ability. This gain in independence may have critical importance for the amount of nursing care required by these patients.

Activities of Daily Living↗
PubMed1984

Anticholinesterase drugs in the treatment of chronic pain.

Two patients with severe thalamic pain and one patient with causalgia from the shoulder-hand syndrome are described whose pain was markedly improved or abolished by anticholinesterase drugs. Both short-acting parenteral and oral anticholinesterase preparations were employed. Anticholinesterase drugs are a new and potentially valuable approach to the treatment of chronic pain.

Arm↗
PubMed1985

Abraham Colles: fracture of the carpal extremity of the radius.

Colles' fracture of the wrist is among the most common bony injuries encountered in emergency practice, and accounts for 10% to 20% of all fractures. Described in an excellent clinical treatise some 8 decades before the advent of radiographs, this fracture of the distal radius continues to pose a source of some disability to large numbers of patients. Complications include residual deformity, loss of mobility, median and ulnar nerve injury, shoulder-hand syndrome, and rupture of the extensor pollicis longus tendon. Although encountered in patients of either sex and in all age groups, this injury classically affects postmenopausal women, who are predisposed to it as a consequence of osteoporosis. The technique of immobilization appears not to be as important in influencing final outcome as does the precision of reduction.

Carpal Bones↗
PubMed1994

Probable cervical midline epidural septum complicating the treatment of a patient with upper extremity sympathetically maintained pain.

We present a woman who developed left arm sympathetically maintained pain (SMP, or "shoulder-hand syndrome") as a result of brachial plexus injury. After confirmatory diagnosis with both stellate local anesthetic block and intravenous phentolamine infusion, the patient had a cervical epidural catheter placed and a local anesthetic infusion started. After numerous unilateral blocks were obtained, a cervical epidurogram demonstrated a probable cervical midline epidural septum. Catheter placement was adjusted, and a successful chemical sympathectomy was performed for 6 days. This resulted in significant relief of the patient's shoulder pain as well as almost complete resolution of the patient's left arm SMP symptoms. This case represents, to our knowledge, the first documentation of the use of phentolamine for the diagnosis of SMP secondary to pathology at a site proximal to that of symptomatology, as well as the first documentation of presumptive cervical midline epidural septum.

Adult↗
PubMed1986

Hemiplegic shoulder pain.

This article reviews the literature relevant to the possible causes, prevention, and treatment of hemiplegic shoulder pain. Shoulder pain and stiffness impede the rehabilitation of patients with hemiplegia. The cause of this complication is unknown, but it may be related to the severity of neurological deficits, preexisting or posthemiplegic soft tissue injury, subluxation, brachial plexus injury, or shoulder-hand syndrome. Shoulder pain may be preventable if risk factors can be identified and appropriate prophylaxis applied. Resolution of the condition depends on diagnosis and effective treatment at the onset of the symptoms. More clinical research is needed to clarify the cause of hemiplegic shoulder pain and to document the efficacy of prophylactic and treatment methods.

Brachial Plexus↗
PubMed1987

Shoulder disorders in the elderly (a hospital study).

One hundred acute geriatric inpatients were assessed to investigate the prevalence of shoulder disorders; 21 had symptoms due to shoulder disease. Conditions included supraspinatus tendinitis (five), chronic rotator cuff rupture (seven), frozen shoulder (two), glenohumeral osteoarthritis (two), apatite related shoulder arthritis (one), stroke related shoulder disease (six). (Some patients had more than one shoulder condition.) The last group included painful stiff shoulders (three), glenohumeral subluxation (two), and acute shoulder-hand syndrome (one). Patients with rotator cuff rupture had bilateral disease. Only three patients had sought medical attention for their symptoms. The common occurrence of these conditions has possible implications for rehabilitation, and medical awareness is required as few may volunteer symptoms. A community based study is needed to assess the prevalence in the elderly population.

Aged↗
PubMed1990

[Sudeck disease].

In 1900, the Hamburg surgeon P.H.M. Sudeck was the first to describe the clinical and radiological symptomatology of the disorder to which he later lent his name. He devoted his scientific career to this disorder, "acute inflammatory atrophy" of bone and soft-tissue as he called it. He elaborated the histology of the disorder with his students and advocated the pathogenic peripheral humoral theory. In later years seven further attempts to explain the pathogenesis were published. The present paper notes that this disorder, which can be divided into three distinct stages, is diagnosed mainly on the basis of clinical factors, above all in the early stage, and that x-rays in the early stages are difficult to differentiate from those of immobilisation osteoporosis since both disorders can manifest as patchy rare fraction and fibrous osteolysis in subchondral bone and old growth plates. Moreover, the author also notes that 10% of all Sudeck cases are not preceded by trauma; these must be understood as spontaneous Sudeck or as Sudeck after distant disturbances. A few sources also refer to Sudeck's dystrophy in the presence of lymphatic congestion. Another, special form of Sudeck's atrophy, is the shoulder-hand syndrome which, however, cannot always be differentiated precisely from rheumatic disorders or dystrophic contractures.

Adult↗
PubMed1990

Reflex sympathetic dystrophy.

Reflex sympathetic dystrophy, causalgia, Sudeck's atrophy, shoulder-hand syndrome, and transient osteoporosis represent a spectrum of sympathetic disturbances which typically present with regional findings. They are often pauciarticular in distribution and uniquely sensitive to timely therapeutic intervention and to preventative measures. Clinical and radiologic appearances are quite characteristic. Thermographic examination provides a valuable tool for monitoring the therapeutic response. The major factor in therapeutic efficacy is aggressive physical therapy. Although therapeusis has been facilitated by a multitude of agents, therapeutic resistance is unfortunately the circumstance, when intervention is delayed.

Diagnosis, Differential↗
PubMed1989

[Analysis of function in shoulder-arm pain].

Aiming at a particularized functional analysis 70 patients with shoulder-hand syndrome were diagnosed; aspects of reflexotherapy (manual and neural therapy) were taken into consideration on this occasion inclusive a comment on the psychical condition. This article refers to several peculiarities of the interaction therapeutist-patient. The importance of radiological aspects is discussed and cybernetic model-conceptions of biological systems are also mentioned. A comprehensive diagnostic differentiation inclusive search for the source of disturbances and a psychological judgement are recommended.

Adult↗
PubMed1985

[Side effects of antiepileptic therapy. Study of 197 cases].

A study of 197 epileptic outpatients consecutively observed by one Neurologist allowed a prospective study of the side effects of antiepileptic drugs. This study shows essentially that a clinical improvement comparable to that generally reported can be obtained with side effects limited in their number and intensity. The main principle is the routine search of these effects which are not always spontaneously mentioned by the patients, especially intellectual slowness and loss of sexual activity. The detection of the side effects through history and physical examination is far more fruitful than are plasma concentrations of drugs which can be doubly misleading: some plasma concentrations lower than recognized therapeutical levels are efficient however while others are higher and nevertheless necessary and well tolerated. Among the side effects specific to certain antiepileptic drugs, shoulder-hand syndrome due to phenobarbital was noted in 10 per cent of the cases. Furthermore, the frequency of scapulo-humeral periarthritis was significantly higher in the epileptic group than in the controls. Dupuytren's disease was less frequent (8 per cent) and the difference with the controls was not significant. Among the non-specific side effects, nystagmus is a somewhat useful sign in treatments by phenytoin but as with drugs dosages, it must be weighed within the whole clinical picture.

Adolescent↗
PubMed1980

Complications of Colles' fractures.

Patients with Colles' fractures have serious complications more frequently than is generally appreciated. A study of 565 fractures revealed 177 (31 per cent) with such complications as persistent neuropathies of the median, ulnar, or radial nerves (forty-five cases), radiocarpal or radio-ulnar arthrosis (thirty-seven cases), and malposition-malunion (thirty cases). Other complications included tendon ruptures (seven), unrecognized associated injuries (twelve), Volkmann's ischemia (four cases), finger stiffness (nine cases), and shoulder-hand syndrome (twenty cases). In many patients, incomplete restoration of radial length or secondary loss of the reduction position caused the complications.

Arthritis↗
PubMed1983

[Algodystrophy in the chronic stage following treatment with phenobarbital].

A case of phenobarbital-induced algodystrophy is reported. The classical clinical picture is a very often bilateral "shoulder-hand" syndrome which, when associated with articular involvement in the two lower limbs, produces an unusual form known as "extensive". Interest lies in the possible confusion with rheumatoid arthritis. Doubts still persist concerning the physio-pathological mechanism by which the medication may lead to osteo-articular symptoms. An association of several factors is frequently found at the onset of the disease.

Chronic Disease↗
PubMed1981

A prospective study of adhesive capsulitis of the shoulder ("frozen shoulder') in a high risk population.

In order to evaluate risk factors for adhesive capsulitis of the shoulder ("frozen shoulder') a prospective study was carried out in neurosurgical patients, in whom there is a high incidence of capsulitis. Ninety-nine patients were admitted into the study, most of whom had surgical treatment for sub-arachnoid haemorrhage. Ninety-one patients (92 per cent) were followed up at six months, and of these 23 (25.3 per cent) had developed adhesive capsulitis, which was bilateral in three. Three patients developed the shoulder-hand syndrome. By comparing the patients with capsulitis at six months with those in whom no capsulitis was found, we were able to evaluate 28 possible risk factors (Appendix I). The subsequent development of adhesive capsulitis in our patients was associated with, (1) impairment of consciousness, (2) hemiparesis, (3) duration of post-operative intravenous infusion, (4) age, and (5) depressive personality. These five associations were statistically significant. Associations with phenobarbitine therapy and hysterical personality were suggested, but these did not reach statistical significance. Routine treatment with corticosteroids post-operatively did not prevent capsulitis.

Adult↗
PubMed1993

[Duration of rehabilitation and fate of patients with cerebral infarction].

We studied 61 patients with a first stroke, admitted in our rehabilitation center. Functional evolution is usually good, 84% of patients are able to return at home, after a mean of 4.6 months of rehabilitation. Age, sex, severity of the initial deficit, shoulder-hand syndrome, etiology and localisation of stroke are the factors which determine the functional recovery and duration of hospitalisation.

Activities of Daily Living↗
PubMed1996

[Primary algodystrophy of the elbow: an unusual location].

The elbow is a location where algodystrophy is rarely established. When algodystrophy affects the elbow it usually does it in a secondary way, being part of a shoulder-hand syndrome. However the original affectation of the elbow, outside this context, is even more exceptional. In this work we present two cases of algodystrophy originally found in the elbow and we revise the characteristics of this location.

Adult↗
PubMed1996

Connective tissue and joint disease in diabetes mellitus.

Connective tissue is ubiquitous and subject to alterations that result in changes in the extracellular matrix of vessels and tissues leading to the long-term complications of diabetes. This article reviews only those abnormalities of interstitial connective tissue involving skeleton, joints, skin, and periarticular tissues. Abnormalities in the skin and periarticular tissues result in syndromes limiting joint movement, including limited joint mobility, Dupuytren disease, flexor tenosynovitis, carpal tunnel syndrome, stiff-hand syndrome, and shoulder-hand reflex dystrophy. Of these, only limited joint mobility and stiff-hand syndrome occur exclusively in patients with diabetes. In all of these conditions, advanced glycation end products are thought to form as a result of nonenzymatic reaction of glucose with proteins, causing stiffening.

Adult↗
PubMed1985

Cardioneuropathy and extracardiac neural disease.

The pathology of cardiac innervation, both intrinsic and external to the heart (aortopulmonary glomera included), is scarcely known, yet it can be critical to life-threatening disorders in cardiac performance, or to reflexes discharging outside the heart, or both. Evidence has been supplied in cardiac neuroanatomy relevant to cardioneuropathy. The arrhythmogenic potential of imbalanced autonomic input in the heart has been corroborated by histopathologic findings in intrinsic plexuses. In turn, significant neurogenic substrates for cardiomyopathy have not been confirmed. Changes in the extrinsic sympathetic chain (left stellate ganglion) and in the prevailing vagal cardiac plexus were found in subjects with arrhythmias (with long QT interval and ventricular tachycardia/fibrillation, respectively). In myocardial infarction with sudden cardiac death, a complicating mediastinitis often presented and was seen to produce focal inflammation of mediastinal nerve plexus and paraganglia. This can worsen the imbalance in autonomic control of the performance of the heart and interfere with barochemoreflex regulation of the systemic or coronary circulation, or both. Such ill-understood sequelae of infarction as the shoulder-hand, chest pain and Dressler syndromes might also correlate with the newly described neuromediastinitis.

Arrhythmias, Cardiac↗