REFLEX SYMPATHETIC DYSTROPHYReflex sympathetic dystrophy (shoulder-hand syndrome) is a complex of symptoms and signs arising from various painful disorders of the shoulder joint and hand of the same extremity. The syndrome is essentially a combination of scapulohumeral periarthritis and Sudeck's atrophy of the hand and wrist, and occurs with increasing frequency during the middle years of life. Pain and restricted motion of the shoulder may precede or follow the ipsilateral painful hand involvement. The elbow joint is usually spared; when the elbow is involved, there is painful restriction of motion. Osteoporosis of the bones of the involved hand is common and prominent. This syndrome should be differentiated from other cervicobrachial pain syndromes, rheumatoid arthritis, polymyositis, scleroderma, and gout-In addition to specific treatment of the underlying disorder, treatment is directed toward restoration of function. Therapy described for scapulohumeral periarthritis (see above) and Sudeck's atrophy is given simultaneously. The prognosis depends in part upon the stage in which the lesions of the shoulder joint and hand are encountered and the extent and severity of associated organic disease. Early treatment offers the best prognosis for recovery. |
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