Shoulder-Hand Syndrome Following Hemiplegia
2. Clinicopathological Study on the Cerebral Localization and its Pathogenetic Role
1978 Volume 15 Issue 5 Pages 429-436
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1978 Volume 15 Issue 5 Pages 429-436
The shoulder-hand syndrome has been recognized as a reflex neurovascular condition, since Steinbr ocker reviewed the literatures and described it in detail, in 1948 As this condition progresses, marked dystrophic changes will be observed in the skin, the hand muscles and the bone of the affected upper extremity. However, the pathogenetic mechanism of this fairly common syndrome is still unknown.
This paper describes seven autopsied cases with this syndrome, included four with cerebral infarction, one with cerebral hemorrhage and two with intracranial tumor. Six cases except the cerebral hemorrhage case havethe common pathological extent in and round thepremotor region in the territory of the middle cerebral artery adjacent to that of the anterior cerebral artery.
In addition to these autopsied cases, two of three other intracranial tumor cases are confirmed in craniotomy that they have the same region as the common pathological extent.
This syndrome is not associated with cerebral lesions but also a number of medical and surgical conditions in adults such as trauma, myocardial infarction, cervical spondylosis and so on. Although the pathogenetic mechanism in various forms of this syndrome is not completely clear, the above clinicopathological findings may suggest that the cessation of cortical autonomic regulation associated with the damage of the premotor and surrounding areas in the territory of the middle cerebral artery gives rise to the disturbances of the normal reflex vasomotor mechanism in the spinal internuncial pool, which leads to the chain reactions along the transmission pathways as far peripherally as to the shoulder and the hand. This syndrome may be caused by multiple and complex pathogenetic factors. Howhver, among the other possiblefactors, such a cerebral lesion should be considered to play the most important role in the pathogenesis of this syndrome following hemiplegia.
