Shoulder-hand syndrome in neurosurgical patients treated with barbiturates. A long term evaluation.
OBJECTIVE
To assess the incidence of shoulder-hand syndrome (SHS) in neurosurgical patients (head injuries, intracranial ruptured aneurysms and intracranial meningiomas), treated with barbiturates. SHS is a chronic condition characterized by intense tenderness and functional impairment affecting one hand, the shoulder or both. Barbiturates have been identified as cause of SHS, although there is controversial evidence on the incidence of this disorder in patients started on long-term Phenobarbital (PB) therapy.


METHODS
One hundred and twenty-six neurosurgical patients, treated with barbiturates, and a control group of 108 patients, treated with carbamazepine or phenytoin, were enrolled. Both groups were followed up for at least 24 to 36 months.


RESULTS
Thirty-five PB-treated patients (27.6%) experienced SHS. In these patients SHS developed during the first 7 months of therapy and regressed after PB discontinuation or, in 2 cases, after dosage reduction. None of the patients in the control group developed SHS.


CONCLUSIONS
The occurrence of SHS in the study group was much more common than that reported previously. This higher incidence should depend upon the coexistence of separate risk factors such as age over 50 years, surgery and intracranial pathology. Early diagnosis and rapid withdrawl of treatment are important for symptomatic relief and full functional recovery.
De Santis
A
A
Institute of Neurosurgery, University of Milan, Ospedale Maggiore, IRCCS, Italy.
Ceccarelli
G
G
Cesana
B M
BM
Bello
L
L
Spagnoli
D
D
Villani
R M
RM
D000328:Adult; D001463:Barbiturates / Q000009:adverse effects*; D006259:Craniocerebral Trauma / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010634:Phenobarbital / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D011336:Probability; D012019:Reflex Sympathetic Dystrophy / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012640:Seizures / Q000517:prevention & control*; D013997:Time Factors
D001463:Barbiturates; D010634:Phenobarbital