Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha   410013, Hunan Province, China

Yi Yuan ★, Master, Attending physician, Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha  410013, Hunan Province, China Yuan Y, Zi XH, Huang X. Sensory changes, C- and A-fiber function, and shoulder-hand syndrome in hemiplegic patients after stroke. Neural Regen Res 2008;3(7):760-3

Abstract

BACKGROUND: Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers.

OBJECTIVE: To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome.   

DESIGN, TIME AND SETTING: A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001.

PARTICIPANTS: Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group.

METHODS: A TSA2001 quantitative sensory testing device (Medoc, Israel) was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia.

MAIN OUTCOME MEASURES: Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups.

RESULTS: Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group (P < 0.05), with the primary manifestations being decreased cold threshold (P < 0.05) and increased warmth threshold (P < 0.05). The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group (P < 0.05). There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds.

CONCLUSION: The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.

Key Words: shoulder-hand syndrome; stroke; quantitative sensory testing

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