Median Neuropathy After Blood Draw Mimics Painful Clenched Fist Syndrome in a Child

Abstract

Background: Clenched fist syndrome is a rare disorder, often attributed to a conversion disorder without anatomic basis. Here, we review the literature surrounding clenched fist syndrome and challenge the assumption it is always psychiatric in origin, via description of a case of clenched fist syndrome responsive to surgical nerve decompression. Methods: An unusual case of clenched fist syndrome is reviewed and discussed. Results: A child presenting with clenched fist syndrome failed conservative measures consisting of formal hand therapy, multidisciplinary pain management, and psychiatric treatment. On clinical examination, she had findings consistent with median nerve entrapment. After undergoing surgical decompression of the median nerve in the forearm and carpal tunnel, the clenched fist resolved immediately. Conclusions: Nerve compression may be an unrecognized factor underlying some cases of clenched fist syndrome. Evaluation by a hand surgeon or a hand therapist skilled in the detection of peripheral nerve entrapment or injury should be considered as part of the workup for this rare disorder.

Cross-Sectional Evaluation of the Economic Burden on Patients Seeking Surgical Treatment for Chronic Nerve Injuries

“…The same situation exists for multiple of the other chronic nerve injury conditions treated in our patient population. Similar arguments to those above have been made elsewhere for complex regional pain syndrome, 16,37 painful neuroma, 17,18,21,62 chronic migraine headaches responsive to peripheral nerve blocks, 19,20,[63][64][65][66] and phantom limb pain. 67,68 The basis of any effective treatment is to target the cause.…”

“…In a sampling of 55,686 patients, they found that average health care charges were 3-fold higher for NP patients than matched control subjects ($17,355 vs $5715, respectively in year 2000). 35 Although Berger et al 35 examined medically managed patients, both causalgia 16,37 and PDN 38,39 have been repeatedly shown to be amenable to surgical intervention, and patients with both of these conditions were included in our study population, providing some degree of overlap to allow for drawing comparisons.…”

Decompression with Brachioradialis Tenotomy Improves Pain and Quality of Life in Patients with Radial Sensory Nerve Compression

“…Although in most cases these symptoms resolve over time, they may require intervention or evolve into CRPS. [29][30][31] Nerve injuries from vascular access may be prevented with Plastic and Reconstructive Surgery • April 2023 648e increased awareness of anatomical distribution of nerves and with improved recognition and reporting of these injuries. 32 Furthermore, chronic pain and disability may be avoided after nerve injury with prompt referral and management.…”