CORTISONE IN TREATMENT OF SHOULDER-HAND SYNDROME FOLLOWING ACUTE MYOCARDIAL INFARCTION

THE TERM shoulder-hand syndrome has been given to a painful disability of the shoulder or hand, or both, which is seen as a complication of myocardial infarction, hemiplegia, protruded cervical intervertebral disk, or cervical osteoarthritis. In coronary disease this dystrophy occurs too frequently to be coincidental and therefore must be recognized as a distinct clinical entity. The initial stage of the syndrome begins with a painful shoulder followed by swelling, pain, and stiffness of the hand and fingers. The condition occurs within six months of an acute myocardial infarction, most cases developing coincidentally with or within four weeks after the attack. The complication has been attributed to reflex spasm of the muscles and ligaments around the shoulder secondary to cardiac pain impulses which are referred to the same segments of the spinal cord as innervate the affected muscles and ligaments. According to this view,¹ afferent stimuli enter the cord