Bilateral Shoulder-Hand Syndrome Associated with Phenobarbital Administration

Shoulder-Hand syndrome (SHS), or reflex sympathetic dystrophy of the upper extremity, is a neurovascular condition affecting the shoulder and hand.1 Pain, swelling, vasomotor disturbances, restricted range of motion, impaired function, and dystrophic changes of the skin and bones of the involved extremity are important manifestations.2 Pain inhibits the range of motion and function of the extremity early in the disease.3 If the condition is uninterrupted, contractures of the hand and shoulder develop because of mechanical restriction.3 Shoulder-Hand syndrome is associated with a wide variety of disorders, such as cervical disk disease, myocardial infarction, trauma, and cerebrovascular lesions.1 The precipitating factor is unknown in one-fifth of the cases of SHS and remains to be investigated.1 Various treatment modalities are reported in the literature, but agreement on the choice and potential benefit of treatment is lacking.4