Hand Infection Associated with Clenched Fist Syndrome in Residents of Long-Term Care Facilities

Balakrishnan, Chenicheri; Bradt, Lisa M; Sylora, Roxanne L; Kavali, Carmen M

doi:10.3928/0279-3695-20020301-11

Cited by 4 publications

(1 citation statement)

References 5 publications

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“…Bu hastaları içeren geniş bir çalışmada hastaların yalnızca %8'inde tam düzelme gözlenirken, %20'sinde kısmi düzelme gözlenmiştir (1). YES'de fonksiyon kaybı, ağrı ve kötü el hijyeninin sebep olduğu avuç içi enfeksiyonlar asıl ilişkili problemlerdir ve düzeltilmeye çalışılmalıdır (1,2,8).…”

Section: Kbas'nin Tanısı Yaygın Olarak Uluslararası Ağrı çAlışma Dern...unclassified

Yumruk El Sendromu: Olgu Sunumu

YAVUZ¹

2022

Bolu Abant Izzet Baysal Universitesi Tip Fakultesi Abant Tip Dergisi

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ÖzAmaç: İstirahatte nötral pozisyona dönmeyen, sabit distoninin ellerde görülen izole formu olan yumruk el sendromu (YES), fokal el distonisiyle karışabilen, tanımlanması uzun, tedavisi zor bir durumdur. YES' li bir olguyu sunarak, ayırıcı tanısını ve tedavisini tariflemeyi amaçladık.Olgu: Olgumuz YES tanısı konulan 22 yaşında erkek hasta, yaklaşık 3 aydır ilerleyici şekilde sol elini açamama ve kullanamama şikayetiyle geldi. Tramva tariflemiyordu. Zamanla sol eli yumruk şekline gelmişti. Elektromiyografisi, servikal, pleksus ve kranial manyetik rezonans görüntülemesi normal olarak değerlendirilmişti. İlaç kullanımı yoktu. Fizik muayenesinde, omuz, dirsek ve başparmak eklem hareket açıklıkları normaldi. Sol elin dorsalinde hafif ödem mevcuttu. Sol el parmaklar proksimal interfaringeal eklemden, 100 derece fleksiyonda, aktif nötrale gelmiyor, pasif zorlama ile -15 derece extansiyonda kalıyor. Distal interfaringeal eklemler yaklaşık 50 derece fleksiyondaydı. Zorlamayla nötral pozisyona getirilebiliyordu. Elde belirgin trofik değişiklik ve tırnak değişikliği gözlenmedi. Hastanın hikâyesinde ve muayenesinde hiperestezi, hiperaljezi ve allodini; ciltte ısı, renk ve terleme değişikliği yoktu. Hasta fizik tedavi programına alındı. Psikiyatrik konsültasyon istenmesini reddetti. Tedavi sonrası eklem kontraktürlerinde kısmi iyileşme gözlendi.Sonuç: Sabit distonili hastalarda primer ve sekonder sebepler ekarte edildikten sonra tanıya ve tedaviye yönelik invazif yaklaşımlardan kaçınılmalı; içerisinde fizik tedavi uzmanı, psikiyatrist gibi uzmanların bulunduğu ekiple multidispliner yaklaşılmalıdır.

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Section: Kbas'nin Tanısı Yaygın Olarak Uluslararası Ağrı çAlışma Dern...unclassified

Yumruk El Sendromu: Olgu Sunumu

YAVUZ¹

2022

Bolu Abant Izzet Baysal Universitesi Tip Fakultesi Abant Tip Dergisi

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Clenched fist syndrome with palmar lichen planus

et al. 2004

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A 16‐year‐old girl had a 4‐year history of hyperkeratosis and fissures on the palm. The skin lesions had gradually progressed to thick hyperkeratosis with mild pruritus, diffusely covering the right palm, and leading to flexion contractures of the fingers with mild pain. There was no family history of similar lesions. Her father had died 4 years previously. Dermatologic examination revealed hyperkeratosis, scaling, a mild yellow color, fissures, and maceration on the palm and volar surface of the fingers of the right hand (Fig. 1). There was an approximately 3 cm × 4 cm hyperkeratotic lesion on the palm of the left hand. 1 Hyperkeratosis with a mild yellow color, scaling, fissures, maceration on the palm and palmar surface of the fingers, and flexed fingers of the right hand Flexion contractures were found at the metacarpophalangeal and proximal interphalangeal joints of the three fingers of the right hand (Fig. 1). There was no pain, tenderness in the joints of the fingers, or palpable nodular lesions on the palmar surface of the hand. Forced extension was difficult, and there was pain with passive extension. Radiography of the patient's hands revealed no abnormality, other than the clenched fingers. Electromyography of the upper extremities was normal. There were no lesions of the oral mucosa. The nails and scalp were normal. The patient showed very poor eye contact, and responded tersely and somewhat reluctantly to questions about her medical history. The patient was evaluated by psychiatry, but did not meet the diagnostic criteria for any mental disorder. There was a schizoid personality characteristic on both the structured clinical interview for DSM‐IV personality disorders (SCID‐II) and the Minnesota Multiphasic Personality Inventory (MMPI). In addition, there was an increase in scores on the hostility and resentment/aggression subscales of the MMPI. The results of routine laboratory tests were within normal limits or negative, including the venereal disease research laboratory (VDRL) test. A skin biopsy specimen showed histopathologic changes of lichen planus (orthokeratotic hyperkeratosis, focal hypergranulosis, acanthosis, papillomatosis, and vacuolization with dense lymphocytic reaction at the dermo‐epidermal junction) (Fig. 2). 2 Hyperkeratosis, acanthosis, papillomatosis, and vacuolization with dense lymphocytic reaction at the dermo‐epidermal junction (hematoxylin and eosin, × 100) The patient was treated with topical 5% salicylic acid and 0.1% methylprednisolone aceponate ointment. Static splinting plus stretching was used for hand therapy. Active assisted motion was employed. The treatment produced a remarkable reduction in the skin lesions (Fig. 3), but no improvement in the flexion posture of the hand. The psychiatric and clinical findings were thought to be consistent with clenched fist syndrome and lichen planus. 3 Normal appearing left hand after treatment

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Discernment and Better Treatment of a Clenched Fist with a Multidisciplinary Approach

Tekin¹,

Başoğlu

Uzun

et al. 2010

The American Surgeon

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Hand Infection Associated with Clenched Fist Syndrome in Residents of Long-Term Care Facilities

Cited by 4 publications

References 5 publications

Yumruk El Sendromu: Olgu Sunumu

Yumruk El Sendromu: Olgu Sunumu

Clenched fist syndrome with palmar lichen planus

Discernment and Better Treatment of a Clenched Fist with a Multidisciplinary Approach

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