Treatment of shoulder-hand syndrome (RSD)
Treatment 1 Pain relief.
Treatment of edema, pain and limitation of motion is most effective when given immediately. Even after several months, if these symptoms are still present, treatment is still effective. It is difficult to change the contracture once the hand has returned to its normal size and color. Effective treatment should emphasize patient trust and relaxation and joint mobility exercises. The relationship between impairment, disability and handicap in patients with RSD has been studied and pain is considered the main cause of disability and handicap. The main goal of treatment is to reduce edema as soon as possible, followed by pain and stiffness, and the condition of the hand must be treated as an emergency.
Treatment 2 Positioning.
Patients should be seated with their upper extremities always on the table in front of them. When moving in a wheelchair, a table should be placed on the wheelchair to ensure that the patient’s hand does not dangle to the side.
Treatment 3 Splinting can be used for this purpose
The principle of splinting is to support the wrist in a moderate dorsal extension position, without the distal end interfering with metacarpophalangeal joint flexion, so that the top of the splint is proximal to the distal transverse palmar line and is properly angled from the first to the fifth metacarpophalangeal joint, with no interference with thumb movement. The splint should be continued until the edema and pain have disappeared and the color of the hand has returned to normal. Self-help activities should be performed while wearing the splint to maintain the mobility of the shoulder.
Treatment 4: Compressional compression centripetal entrapment
Centripetal finger wrapping has proven to be a simple, safe and very effective treatment for peripheral edema. A 1 to 2 mm diameter cord is used to wrap the thumb, then the other fingers, from distal to proximal, starting with a small loop at the finger pinch and then quickly and forcefully wrapping proximally until the root of the finger cannot be wrapped any further. Immediately after wrapping, the therapist quickly pulls the wrapped cord away from the loop at the end of the finger. After wrapping each finger, begin wrapping the hand, again making a loop at the metacarpophalangeal joint, then wrapping from the metacarpophalangeal joint to the proximal end, reaching the base of the thumb, making the thumb tuck in and wrapping the thumb-metacarpophalangeal joint together to the wrist joint. The therapist may wrap the upper extremity from the wrist joint upward. The patient’s family can be taught how to do this to save treatment time.
Treatment 5 Ice therapy
When ice therapy is available, the therapist immerses the patient’s hand in a bucket of ice and water in a ratio of 2:1, so that the hand can be immersed easily and the water temperature is kept cold by the constant melting of the ice. The therapist’s hand should be immersed together to determine the tolerance time of the immersion.
Treatment 6 Active movement should be allowed as much as possible
Even if the hand is completely paralyzed, it should be performed. For example, having the patient lie on his or her back with the upper extremity held up will often stimulate elbow extensor muscle activity. Muscle contraction provides a good pumping effect to reduce edema. Do not do weight-bearing exercises with the elbow extended until the pain and edema have resolved, as these activities may contribute to the development of the syndrome and can cause pain and perpetuate the condition. Any activity or position that can cause pain should be avoided, and the therapist should be aware of the same issues when performing passive joint exercises.
Treatment 7 Passive motion
Careful passive movements of the shoulder joint can prevent shoulder pain; passive movements of the hand and fingers should also be very gentle so as not to cause pain; carpometacarpal problems are often accompanied by a loss of forearm rotation, and the therapist should try to perform forearm rotation in the pain-free range as much as possible during treatment. All of these exercises can be performed with the patient in the supine position with the upper extremity elevated to facilitate venous return. Because therapists are concerned about developing hand contractures, they tend to be too aggressive with passive activities when treating hand swelling. In this case, it is better to do less than more. After the edema subsides and the pain is relieved, joint mobility is quickly restored.
Treatment 8 Oral medication for pain
Commonly used drugs include: corticosteroids, dimethyl sulfide, calcitonin, non-steroidal anti-inflammatory drugs, tricyclic antidepressants, etc.
Treatment9 Stellate ganglion block therapy and high thoracic sympathectomy
Physical therapy
Hot and cold water bath, whirlpool bath, wax therapy, massage, transcutaneous electrical nerve stimulation (TENS), ultrasound, biofeedback.