Psycho-flexed Hand

Journal of the Korean Society for Surgery of the Hand 1997;2(1):56-62.
Published online January 1, 1997.

Psycho-flexed Hand

Duke Whan Chung,Kang II Kim,Chang Moo Yim

정신병적 파악 증후군

정덕환,김강일,임창무

Abstract

Psycho-flexed hand, Clenched fist syndrome, and SHAFT syndrome, is a rare psychological related disease but yet to be reported in Korea, Previous reports from other countries indicated that psycho-flexed hand is mainly associated with psychologic disease like schizophrenia or conversion disorder. Clenched fist represents a conversion phenomenon in which the patient develops a deformity in what is thought to be a symbolic expression of repressed forbidden wishes. Furthermore, the clenched fist also represents feelings of anger that are suppressed by paralyzing the hand. Prior to diagnosing a psychiatric illness as the etiology of flexed fingers. a determined effort must be rule out an organic etiology such as Dupuytren's contracture, Reflex sympathetic dystrophy, Camptodactyly. To diagnosis and treatment of this conversion phenomenon, multidisciplinary approaches are necessary such as involvement of the hand surgeon, neurologist, and psychiatrist. On physical examination, the swelling of the hands are usually persist and the fingers are usually noted to be tightly held within the palm. Attempted passive extension of the fingers results in pain. Interdigital maceration with a malodorous aroma arising from the palm. is also evident. Psychologic examination includes MMPI, EEG, and biofeed back, as well as brain CT are also involved. However, nerve conduction test, EMG, or radiologic evaluations are nonspecific. Treatment of psycho-flexed hand was most likely to be successful when hand surgeon coordinates careful psychiatric and neurologic assessments. At Kyung-Hee University Hospital, we observed a paranoid type schizophrenia patient with flexion contracrures of the index, middle, ring, and little fingers of the right hand, as well as macerated palm. This case was evaluated on physical examination, psychologic and radiological aspects. After the through evaluation, we concluded that this represents a case of psycho-flexed hand. This case was successfully treated with combination of surgical release after adequate psychologic treatment.