There have been quite a number of reports on the diagnostic criteria and managements of shoulder-hand syndrome. In most reports, authors refered to the shoulder pain, spontaneous finger pain or finger pain on flexion and possible pathogenic basis of pain. There are few reports, however, in which tenderness on finger or pain on extension are mentioned. Moreover, the location of pain of fingers and responsible lesions of tissue for pain are rarely discussed.
In our present reports, a total of 47 hemiplegic patients with shoulder hand syndrome were studied from such aspects as hand and fingers pain on flexion and on extension, and tenderness on ligamentous tendon sheath (A₁ pulley) and its entrance on the palm at MP joints. Hand and fingers pain on flexion, extension and tenderness was demonstrated in approximately 80% of the cases studied with particular involvement of index, middle and ring fingers. Six of seven patients with sustained fingers pain were administered steroid in tendon sheath. Reduction of pain was noticed in four cases. Incision and resection of tendon sheath was performed on three patients with sustained severe pain like causalgia, resulting in nearly complete remission of pain.
The pathohistological study of tendon sheath in two patients revealed increased vascularization, cellular infiltration, disarrangement of collagen fibers and hyaline degeneration.
We conclude from our present study that ligamentous tendon sheath and its entrance at MP joints on the palm are chiefly responsible for fingers pain of shoulder-hand syndrome.

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Median nerve, middle latency, somatosensory evoked potentials (SEP) were obtained from 106 consecutive patients with chronic cerebrovascular accident and compared with regard to their sensory-motor deficits. The position sense of the thumb as well as the motor function of fingers were examined, and recorded in five grades. Contralateral central and parietal SEP patterns were classified as follows:
Type I: the most severe type, with no evoked responses after widespread N18.
Type II: some deficits in three negative (central/parietal-NI, NII, NIII) and three positive (central/parietal-P₀, PI, PII) peaks within 100msec.
Type III: all peaks exist within 100msec.
The SEP classification was found to be closely correlated with sensory and motor dificits. However, in 30 cases with dissociated sensory and motor impairments, the SEP classification correlated only with sensory impairment, and the correlation between SEP and motor dificit was inverse (Spearman's rank correlation method was used for statistics). Severity of motor deficit was found not to have any influence on the relationship between SEP and sensory deficit (Wilcoxon's rank sum test was used). From these observation, we conclude that the SEP classification specifically reflects epicritic sensory impairment in stroke patients.

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We evaluated X-ray findings of the shoulder joints of 46 hemiplegic patients to elucidate the postural reduction of the shoulder subluxation on standing. The acromio-humeral interval (AHI) measured in X-ray photographs was 8.3mm±1.5mm on the non-paralytic side and 16.4mm±8.3mm on the paralytic side. If an AHI of more than 13mm in a X-ray photograph meant a shoulder subluxation, 56.5% of the hemiplegic patients we evaluated in this study had shoulder subluxations. AHIs of hemiplegic patients in Brunn-strom's stage I-III decreased on the paralytic side when the patients stood up, and the postural reduction of the shoulder subluxation was statistically significant, especially in the Brunnstrom's stage II patients. We, therefore, concluded that the shoulder subluxation may be reduced by standing, walking, and other daily activities because of the increased muscle tonus around the shoulder joint and the associate and synergic movements of the upper extremity.

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Twenty-seven male hemophiliacs (18-35 years of age) were studied to elucidate the effect of hemophilic arthropathy on the muscle strength and the range of motion. X-ray findings in the knee and ankle joints were classified into five grades according to a modified De Palma's method. Muscle peak torques of the knee extensors and flexors were evaluated by an isokinetic dynamometer (Cybex II) and the range of motion of the knee joints was measured by a goniometer.
The grades of hemophilic arthropathy were worse in the ankle joints than in the knee joints. Though the range of motion of the knee joints that were classified from grade 0 to 3-(1) fell in the normal, the range of motion of the knee joints classified from grade 3-(2) to 4 decreased. The muscle peak torques were decreased with the grade of hemophilic arthropathy, and hemophiliacs without arthropathy had weaker muscle peak torques than healthy men. We, therefore, concluded that the prevention of muscle weakness might be also very important in the rehabilitation of hemophiliacs.

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1) A new method of quantitative evaluation of muscle damage by CT scan was developed and its reliability and reproducibility were tested.
2) Normal values of CT number, cross-sectional area (CSA), %CSA of muscle and fat (the percentage of area having the CT numbers in the range of normal muscle and fat) were reported by age and sex.
3) By means of this quantitative muscle CT evaluation, the progression of muscle damage was studied in the lower extremities of 71 Duchenne muscular dystrophy cases and the following results were obtained.
a) With the progression of disability stage, both CT number and %CSA of muscle decreased, and %CSA of fat increased, indicating loss of muscle fibers and fat tissue replacement.
b) The rate of progression of muscle damage differed among various muscles.
c) There was a tendency for the muscle damage to progress in the following order; peroneal muscles, gastrocnemius→tibialis anterior→soleus→tibialis posterior in the lower leg, and biceps femoris→adductors, quadriceps→semimembranosus, semitendinosus→sartorius, gracilis in the thigh. The mechanisms for this specific pattern of muscle involvement in DMD cases were discussed.
4) Through this study, the natural course of muscle involvement in the lower extremities of DMD cases was clarified, which would be useful in providing appropriate rehabilitative cares to DMD cases as well as assessing the efficacy of therapeutic interventions like medications, physical exercise and bracing. Further study is needed to relate the CT findings to clinical factors such as muscle strength and the pattern of development of contractures and deformities.

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