The clenched fist syndrome a psychiatric syndrome mimicking reflex sympathetic dystrophy

Swift, David W.; Walker, Sara E.

doi:10.1002/art.1780380109

Cited by 20 publications

(15 citation statements)

References 9 publications

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“…The psychiatric symptoms existing in this patient and her life history were similar to those outlined in other case reports of CFS 9–11 . Successful treatment of CFS is most likely with long‐term multidisciplinary therapy.…”

Section: Discussionsupporting

confidence: 79%

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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Section: Discussionsupporting

confidence: 79%

Clenched fist syndrome with palmar lichen planus

et al. 2004

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“…Original and subsequent reports describing the syndrome often mention a minor injury preceding the development of the clenched fist, yet draw no causative link between injury and this physical syndrome, preferentially relying on psychological explanations. 1,6,7,11 Reports have been published to aid clarification of this diagnosis from that of RSD, another pain syndrome, the neurological manifestations of which are out of proportion to an initial inciting injury, and yet the similarities between the 2 entities may be more worth considering than their differentiating factors. The RSD and causalgia are 2 clinically similar entities separated by the absence or the presence, respectively, of a known accompanying nerve injury.…”

Section: Discussionmentioning

confidence: 99%

“…The psychopathological underpinnings of this diagnosis are widely accepted both in the psychiatric and in the hand surgery literature. 1,[4][5][6][7][8][9][10][11][12][13][14] However, controversy existed concerning the degree that symptoms are consciously produced; although some have argued clenched fist to be factitious in nature (unconsciously motivated, but with consciously produced symptoms), 4,5 it is now widely considered a true conversion disorder (unconsciously motivated with unconsciously produced symptoms). 7,12 Rare, poorly understood syndromes are liable to be given a presumptive explanation before their true pathophysiological etiology is elucidated.…”

Section: Introductionmentioning

confidence: 99%

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

Hill

Kahn

Sterni

et al. 2019

Hand (New York, N,Y.)

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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.

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“…8 Figure 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 The psychiatric symptoms existing in this patient and her life history were similar to those outlined in other case reports of CFS. [9][10][11] Successful treatment of CFS is most likely with long-term multidisciplinary therapy. Resistance to treatment is common.…”

Section: Discussionmentioning

confidence: 99%