Clinical Presentation of Shoulder-Hand Syndrome: A Systematic Review

Abstract

Background: Shoulder-hand syndrome (SHS) is a neurological disorder characterised by pain, loss of function, and trophic changes in the shoulder and hand of the affected limb. SHS shares a number of features with Complex Regional Pain Syndrome (CRPS). Historically, several terms have been used interchangeably with SHS, obfuscating clinical presentation. This review aimed to characterise the presentation of SHS to provide a full clinical picture for clinicians and researchers. Furthermore, we aimed to examine whether symptoms differ between triggered and idiopathic SHS, as indicated in previous research. Methods: A systematic search of three databases (PubMed, Web of Science and Google Scholar) and bibliographies was performed. Articles published from 1940 to 2025 describing symptoms of shoulder-hand syndrome in any context were screened for eligibility. Papers were excluded if they used alternative terms in place of ‘shoulder-hand syndrome’, such as reflex sympathetic dystrophy. Results: 16,843 articles were identified, with 33 meeting the inclusion criteria. The clinical presentation of SHS was similar across included studies, with some variations observed between post-hemiplegic (PH) and post-myocardial infarction (PM) SHS patients. The predominant symptoms were pain in the shoulder, accompanied by pain and swelling of the hand. PH patients exhibited more trophic symptoms (e.g., nail growth changes, skin thickening), while PM patients demonstrated joint contractures and stiffness. Conclusions: This review provides a detailed description of the symptoms of shoulder-hand syndrome, including both triggered and idiopathic cases. We hypothesize that SHS might be a sub-type of CRPS; however, more research is required to validate this categorization. Significance Statement: This review provides a detailed description of the symptoms of shoulder-hand syndrome. This information may be useful for clinicians and researchers examining cases of SHS and possibly contrast this with CRPS. A concerted effort to phenotype these patients, including the influence of inciting events, using modern techniques such as quantitative sensory testing would be useful. We propose that SHS may be a sub-type of CRPS and if confirmed should be classified accordingly, however more research is needed.