Avoiding Overuse in German Gynaecology and Obstetrics - Adaptation of the Canadian "Choosing Wisely" Recommendations.

Shoulder-hand syndrome (SHS) is also known as reflex sympathetic dystrophy (RSD) (). It is a highly prevalent and disabling complication following a stroke (). The International Association for the Study of Pain (IASP) currently categorizes this condition as type I complex regional pain syndrome (CRPS-I) (). It typically develops 1–3 months post-stroke. This timeframe is a critical phase for patient rehabilitation. The incidence rate among stroke survivors is reported to be 49% (). A recent retrospective review identifies the primary symptoms of SHS. These include pain, swelling, and motor dysfunction in the affected shoulder and hand (). Without prompt intervention, patients in advanced stages experience muscle and joint atrophy alongside irreversible disability (). Furthermore, SHS is a chronic and persistent condition. It imposes long-term financial and psychological burdens on patients. Research indicates that 31% of individuals are unable to return to work within 2 years of disease onset (). This leads to a substantial increase in medical expenses. Additionally, the prevalence of anxiety and depressive symptoms among these patients rises significantly (). Despite extensive research, the exact pathological mechanism of SHS remains unclear (). Most studies closely link its onset to post-traumatic inflammation. Elevated levels of TNF-α, IL-6, IL-8, and substance P are considered the primary drivers (). Additionally, central sensitization plays a significant role in the development of this condition.