Clenched Fist Syndrome Research Articles

Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm.

This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018. A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days. Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.

Clinical and prognostic aspects of patients with the Neuromyelitis Optica Spectrum Disorder (NMOSD) from a cohort in Northeast Brazil

IntroductionNeuromyelitis optica spectrum disorders (NMOSD) is a rare inflammatory and demyelinating disease of the central nervous system (CNS) more frequent in women and Afro-descendants. No previous epidemiological or prognostic study has been conducted in the region of the state of Bahia, Brazilian Northeast.ObjectiveTo evaluate clinical and prognostic aspects in patients with NMOSD from a cohort in northeastern Brazil.Material and methodsA single-center retrospective study was conducted with consecutive patients diagnosed with NMOSD. Clinical and epidemiological characteristics were described. The degree of disability was expressed by the Expanded Disability Status Scale (EDSS). Worsening disability were analyzed through negative binomial regression adjusted for disease duration.ResultsNinety-one patients were included, 72 (79.1%) female and 67 (73.6%) afro descendants. Mean age at onset was 36 (± 14) years and 73.3% were anti-aquaporin-4 antibody positive. Isolated transverse myelitis (32.9%) and isolated optic neuritis (22.4%) were the most frequent initial clinical syndromes. After multivariate analysis, optic neuritis (RR = 0.45; 95% CI = 0.23 – 0.88; p = 0.020) and dyslipidemia (RR = 0.40; 95% CI = 0.20 – 0.83; p = 0.014) were associated with slower disease progression. Area postrema involvement (RR = 6.70; 95% CI = 3.31 – 13.54; p < 0.001) and age at onset (RR = 1.03; 95% CI = 1.01 – 1.05; p = 0.003) were associated with faster disease progression.ConclusionsIn the first clinical and prognostic study in northeastern Brazil, we identified area postrema involvement, age at onset, optic neuritis at fist syndrome and dyslipidemia as the main prognostic factors associated with disease progression.

Clenched Fist Syndrome in an Adolescent Girl

Clenched Fist Syndrome in an Adolescent Girl

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

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.

Clenched fist syndrome: a case report

BackgroundThe clenched fist syndrome/psycho-flexed hand, first described in the early 1980s, has not yet entered the major psychiatric textbooks. Curiously, the phenomenon has been illuminated mainly in journals and textbooks on hand surgery. There is a need to examine, describe, and understand this syndrome from a psychiatric perspective.Case presentationWe present a case we encountered in an intensive care unit. A 60-year-old white man with schizophrenia, cerebrovascular disease, diabetes mellitus type 2, and peripheral neuropathy, developed rather acutely bilateral clenched fists in the aftermath of a traumatic dislocated hip fracture that was operated on. He later died due to complications from the surgical procedure.ConclusionsWhile this was a complex case with some clinical uncertainty regarding the cause of our patient’s symptoms, we conclude that psychological processes were central to the development of his clenched fists. The phenomenon of clenched fists and our case are discussed with reference to the accumulated literature on psychogenic hand disorders and the International Statistical Classification of Diseases and Related Health Problems, 10th version. The nosological status appears to be obscure. This case presentation is a first step in increasing the understanding of this syndrome from a psychiatric perspective.

Poster 379 Clenched Fist Syndrome: Treatment with Local Injection under Ultrasound Guidance. A Case Report

PM&RVolume 7, Issue 9S p. S215-S215 Musculoskeletal and Sports Medicine Poster 379 Clenched Fist Syndrome: Treatment with Local Injection under Ultrasound Guidance. A Case Report Amit Bhargava MD, MS, Amit Bhargava MD, MS Advanced Interventional Pain & Sports Medicine Center, Owings Mills, MD, United StatesSearch for more papers by this authorBruce Wolock MD, Bruce Wolock MD Advanced Interventional Pain & Sports Medicine Center, Owings Mills, MD, United StatesSearch for more papers by this authorKaren James OTR/CHT, Karen James OTR/CHT Advanced Interventional Pain & Sports Medicine Center, Owings Mills, MD, United StatesSearch for more papers by this author Amit Bhargava MD, MS, Amit Bhargava MD, MS Advanced Interventional Pain & Sports Medicine Center, Owings Mills, MD, United StatesSearch for more papers by this authorBruce Wolock MD, Bruce Wolock MD Advanced Interventional Pain & Sports Medicine Center, Owings Mills, MD, United StatesSearch for more papers by this authorKaren James OTR/CHT, Karen James OTR/CHT Advanced Interventional Pain & Sports Medicine Center, Owings Mills, MD, United StatesSearch for more papers by this author First published: 08 September 2015 https://doi.org/10.1016/j.pmrj.2015.06.415Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume7, Issue9SSeptember 2015Pages S215-S215 RelatedInformation

Psychopathological Hand Disorders: A Rare Somatoform Reaction to Psychological Conflicts

Psychopathological Hand Disorders: A Rare Somatoform Reaction to Psychological Conflicts

P-1366 - Psychopathological hand disorders: a rare somatoform reaction to psychological conflicts

This article introduces two cases of pathological hand disorder, a rare category associated with contractures of fingers and abnormal posture of the hand. Both of these patients had history of traumatic life experiences in the past and their hand deformity could not be explained by a general medical condition. Psychopathological hand disorders including clenched fist syndrome and psychoflexed hand are somatoform conditions which represent “conversion” of emotional turmoil to physical symptoms in a symbolic manner. Prognosis seems to be poor . This fact is partly related to the interdisciplinary nature of the problem. The patient needs simultaneous psychiatric, neurologic and surgical help to reach both the proper diagnosis and management. Without considering the underlying psychological conflicts, invasive procedures are not helpful. Involvement of the key family members can be helpful for the patient to overcome the feeling of loneliness and helplessness. On the other hand, unnecessary and too much attention can be a rewarding response which keeps the situation unchanged. The patients need consistent, supportive care by their therapist to help them to get more adaptive solution for their problems. The therapist needs to know the protective role of the symptom and the patient's need to keep and maintain this posture. In some patients , the symptoms protect them from more destructive behaviors. This behavior shows the need to cope with unbearable psychological distress and to regain a sense of stability. These needs have to be addressed before any corrective intervention.

Bilateral hand amputation due to clenched fist syndrome

Bilateral hand amputation due to clenched fist syndrome

The Clenched Fist Syndrome: A Presentation of Eight Cases and an Analysis of the Medicolegal Aspects in Denmark

Clenched fist is a rare disorder of the hand associated with fixed contractures of fingers. The condition is often preceded by minor trauma or surgery, but these do not explain the severity of the contractures. Extension of the fingers is painful and hygienic problems can be considerable. Psychiatric disease is frequent in clenched fist patients. The patients may express a strong wish for amputations. In a review of eight patients with clenched fist who had claimed economic compensation from the Danish Patient Insurance Association, four patients had amputations. Three of them subsequently developed new contractures.

The Clenched Fist Syndrome Revisited

Sir:The clenched fist syndrome has been reported as a finding associated with conversion phenomenon. Other mental disorders manifesting as hand abnormalities include the “psycho-flexed hand” and SHAFT syndrome. Manifestations of psychiatric disorders as significant hand abnormalities have been repor

Clenched fist syndrome with palmar lichen planus

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.Hyperkeratosis with a mild yellow color, scaling, fissures, maceration on the palm and palmar surface of the fingers, and flexed fingers of the right handimageFlexion 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).Hyperkeratosis, acanthosis, papillomatosis, and vacuolization with dense lymphocytic reaction at the dermo‐epidermal junction (hematoxylin and eosin, × 100)imageThe 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.Normal appearing left hand after treatmentimage

Complex regional pain syndrome I (reflex sympathetic dystrophy).

Complex regional pain syndrome I (reflex sympathetic dystrophy).

SHAFT syndrome revisited.

Wallace aptly described patients with overriding psychological problems and upper extremity complaints as possessing the Shaft syndrome. SHAFT patients studied fell into two categories. The first group inflicted physical harm on themselves, creating factitious injuries. The second group postured their limbs in attitudes that are not explainable anatomically. This latter group is described by Simmons as the clenched fist syndrome. Although patients who had factitious injuries invariably healed with protective casting, 4 patients relapsed. Eight of 14 patients who were employed at the onset of their complaints returned to gainful employment. Some patients received psychological counseling but most lacked sufficient insight to make gainful progress. Reaching a diagnoses was often difficult. At least 5 patients had unwarranted operations. The surgeon needs a high index of suspicion when the history and findings do not match for patients harboring complaints of pain, numbness, stiffness, or inability to use their limb.

The clenched fist syndrome a psychiatric syndrome mimicking reflex sympathetic dystrophy

We describe a patient with swelling and pain in his right hand, which persisted for 1 year after minimal trauma. We think this represents a case of "clenched fist syndrome," a conversion disorder with unique somatic features that is easily mistaken for reflex sympathetic dystrophy syndrome. Included is a comparison of other psychological illnesses in which unusual physical findings involve the hand.

The clenched fist syndrome

The clenched fist syndrome

The clenched fist syndrome

The clenched fist syndrome is an entity in which the patient keeps one or both hands tightly clenched. It is seen in all groups; hand dominance or compensation is not a factor. It usually follows a minor inciting incident and is associated with swelling, pain, and paradoxical stiffness. No organic disease can be found and extension of the fingers is always possible under anesthesia. Psychiatrically the patient is classified as having severe anger and poor defense. The prognosis is poor.