The Clenched Fist Syndrome Revisited

Zeineh, Linda L.; Wilhelmi, Bradon J.; Seidenstricker, Lynn

doi:10.1097/01.prs.0000300211.32174.56

Cited by 6 publications

(3 citation statements)

References 3 publications

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“…Most often the disorder involves both interphalangeal joints. Additional psychiatric comorbidities are almost always present in patients with CFS and a thoroughly psychiatric assessment should be performed in the first consultation [3, 7–9, 13, 14]. Our patient showed an unexplainable flexion contracture of all digits at the level of the proximal and distal interphalangeal (PIP and DIP) joints of the right hand resembling previously described cases with no prior trauma.…”

Section: Discussionsupporting

confidence: 75%

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The clenched fist syndrome: case report of a clinical rarity of special interest for psychiatrists and hand surgeons

Meiwandi

Papadakis

2019

BMC Psychiatry

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BackgroundThe Clenched Fist Syndrome (CFS) is a type of a psychiatric disorder, in which the patients show flexion finger contractures. Although no organic etiology can be identified, the syndrome in most cases presents with pain and paradoxical stiffness.Case presentationWe, herein, report the case of a 52-year old woman with a 6-month history of progressive hand flexion contracture and intermittent numbness in the first 3 fingers, mimicking carpal tunnel syndrome. On examination, all digits, including the thumb, were held in a tight flexion at the metacarpal and interphalangeal joints. Passive digital extension was painless in all fingers. Physical examination did not reveal any joint tenderness, joint or tendon sheath swelling. X ray was performed and did not show any abnormalities. Neurological examination did not reveal any organic etiology.ConclusionsCFS is believed to be a conversion disorder, i.e. unconsciously motivated and produced, whereas others consider it a factitious disorder, i.e. unconsciously motivated but consciously produced. Surgical treatment is not indicated, as it can worsen the symptoms. The related literature is discussed. We conclude that CFS should always be considered in patients with unexplainable flexion hand contractures, especially in the presence of a positive psychiatric history.

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Section: Discussionsupporting

confidence: 75%

“…In advanced cases, the contractures become permanent due to changes in the soft tissue, joints and tendons. Macerations and infections due to palm hygiene problems also occur in these cases [3, 7, 8, 13]. In our patient, all fingers including the thumb were affected at the level of metacarpal and interphalangeal joints.…”

Section: Discussionmentioning

confidence: 70%

The clenched fist syndrome: case report of a clinical rarity of special interest for psychiatrists and hand surgeons

Meiwandi

Papadakis

2019

BMC Psychiatry

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“…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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Psychosocial Aspects of Arm Illness

Vranceanu¹,

Ring²

2011

Rehabilitation of the Hand and Upper Extremity, 2-Volume Set

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The Clenched Fist Syndrome Revisited

Cited by 6 publications

References 3 publications

The clenched fist syndrome: case report of a clinical rarity of special interest for psychiatrists and hand surgeons

The clenched fist syndrome: case report of a clinical rarity of special interest for psychiatrists and hand surgeons

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

Psychosocial Aspects of Arm Illness

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