Shoulder-hand syndrome in cervical spinal cord injury

To characterize the occurrence of shoulder-hand syndrome (SHS) complicating the rehabilitation of patients with cervical spinal cord injury, we reviewed the medical records of 43 consecutive patients admitted to the Burke Rehabilitation Center with cervical spinal cord injury, focusing on the clinical features of SHS: shoulder pain, hand/wrist pain, edema, vasomotor changes, trophic changes and osteoporosis on x-ray. Twenty-seven patients (63%) had three or more features of SHS. The number of features correlated with age (r = 0.495, p = 0.0007), but not with the presence of upper or lower motor neuron findings in the arms, or with autonomic dysfunction. Twenty-three of 25 (92%) SHS patients with adequate follow up had satisfactory resolution of symptoms with conservative therapy (i.e. neither systemic corticosteroids nor stellate ganglion block), but only after a mean of 121 days (range 42-274 days).