Jpn J Rehabil Med 2015 ; : 126.131 MRI 1 1 23 2 2 Two Cases of Shoulder-Hand Syndrome after Stroke : Clinical Symptoms and MRI Findings Hiroko YAMANAKA, 1 Hidekata YAMANAKA, 1 Masayuki WAKITA, 2, 3 Yoshiya HASHIGUCHI, 2 Junji KASUYA 2 Abstract : In two cases of poststroke shoulder-hand syndrome, the patients complained of hemi-paretic shoulder pain. Both cases showed characteristic findings on magnetic resonance imaging MRI of the paretic shoulder. Case 1 underwent MRI before the syndrome occurred, while Case 2 underwent MRI after the syndrome occurred. In both cases, chemical saturation T 2- weighted images revealed high intensity signals mainly anterior to the scapula, but also surrounding the articular capsule of the shoulder joint. Also, the subscapular muscle and subscapular bursa appeared damaged, and bloody fluid extended into the connective tissue. In Case 2, chemical saturation T 2-weighted images revealed high intensity signals in the axillary fat. The paretic hands of both patients showed conscious and objective allodynia, edema, and decreased range of finger flexion and carpal extension. Observed symptoms were consistent with a diagnosis of complex regional pain syndrome CRPS. Adherence of the posterior brachial plexus to the subscapular muscle may result in positional relationship changes and tears to the cords when the paretic shoulder is moved. The resultant small fiber neuropathy may result in edema by conduction block. Furthermore, aseptic synovitis from neurogenic inflammation may also occur. In Case 1, the arthritis of the shoulder appeared before the neuropathy. This indicates that damage to the subscapular bursa rather than neuropathy may be the underlying cause of the arthritis. Jpn J Rehabil Med. Key words : shoulder-hand syndrome subscapular muscle subscapular bursamri magnetic resonance imaging of the shoulder aseptic synovitis 1 3 1994 IASP shoulder-hand syndrome SHSRSD 4 Reflex Sympathetic Dystrophy 1 Complex regional pain syndrome type 1 CRPS I 5 CRPS I 6 7 8 Oaklander 9 CRPS I small- 2014 8 26 2015 1 10 1 890.0068 11.6 Department of Neurology, Atsuchi Rehabilitation Hospital 2 892.0842 4.13 Department of Neurology, Atsuchi Neurosurgical Hospital 3 892.0853 8 E-mail : yamanaka-hiroko@umin.ac.jp 126 Jpn J Rehabil Med VOL. 52 NO. 2 2015
2 fiber neuropathy CRPS CRPS 10 SHS CRPS RSD Wrist-hand syndrome 4 SHS 2 magnetic resonance imaging MRISHS 1 1 SHS 1 67 4 2 Brunnstrom Stage BRS 4 MRI 6.4 SHS 49 BRS 8 SHS PIP Proximal interphalangeal jointmp Metacarpophalangeal joint 11 1 2 28.3 PIP MP DIP Distal interphalangeal 35 110 80 40 50 68 2 BRS 17 4 1 40 BRS 6 SHS 12.9 MRI 20.9 MP PIP DIP 20 150 120 20 31 42 7.4 MRI 59 BRS mm cm 70 MP 90 MP 45 PIP 100 60 1 SHS 6 21.0 22.5 34.0 32.5 70 45 100 5 60 80 30 100 50 2 SHS 5 20.5 25.0 34.3 33.9 70 90 90 30 35 65 15 65 20 range of motion MP metacarpophalangeal PIP proximal interphalangeal BRS Brunnstrom stage SHS shoulder-hand syndrome. BRS BRS Jpn J Rehabil Med VOL. 52 NO. 2 2015 127
1 MRI A T13.0 T TR 800 ms TE 9.60 msb T23.0 T TR 4400 ms TE 83.20 ms C T2 3.0 T TR 4400 ms TE 81.92 ms D T2 3.0 T TR 4400 ms TE 81.92 ms E FC D C D 20.7 BRS ADL SHS 120 140 40 MRI GE SIGNA EXCITE HD 3.0 T T1 T2 12 T2SHS T2 B B T2 1C 2C 1D 2D 2 T2 2B 2A BSHS 3 T2 2F G 1 1E 2 2E SHS MRI T2 128 Jpn J Rehabil Med VOL. 52 NO. 2 2015
2 2 3 MRI A 2 T13.0 T TR 800 ms TE 9.05 msb 2 T23.0 T TR 4400 ms TE 86.47 ms C 2 T2 3.0 T TR 4400 ms TE 83.33 ms D 2 T2 3.0 T TR 4400 ms TE 83.33 ms E 2 F 3 T23.0 T TR 4400 ms TE 86.18 msg 3 T2 3.0 T TR 4400 ms TE 87.68 ms 12 RSD 4 12 SHS score 2 SHS 2 SHS 1 MRI 2 T2 SHS 2 small-fiber neuropathy 3 SHS Braus Jpn J Rehabil Med VOL. 52 NO. 2 2015 129
2 Manual Muscle Testing 2 SHS 2 13 SHS 14 12 Substance P Calcitonin gene-related peptide IL 6 7 2 3 15 16 Falsetti Wrist-hand syndrome RSD 20 mm 130 Jpn J Rehabil Med VOL. 52 NO. 2 2015
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