Hill Elspeth J R, Kahn Lorna C, Sterni Lynne M, Mackinnon Susan E, Felder John M
Washington University School of Medicine, Saint Louis, MO, USA.
Hand (N Y). 2020 Mar;15(2):NP31-NP36. doi: 10.1177/1558944719837674. Epub 2019 Apr 8.
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. An unusual case of clenched fist syndrome is reviewed and discussed. 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. 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.
握拳综合征是一种罕见的疾病，常被归因于无解剖学基础的转换障碍。在此，我们回顾了围绕握拳综合征的文献，并通过描述一例对手术神经减压有反应的握拳综合征病例，对其总是源于精神疾病的假设提出质疑。我们回顾并讨论了一例不寻常的握拳综合征病例。一名患有握拳综合征的儿童接受了包括正规手部治疗、多学科疼痛管理和心理治疗在内的保守治疗，但均告失败。临床检查发现，她的症状与正中神经卡压相符。在前臂和腕管进行正中神经手术减压后，握拳立即消失。神经受压可能是某些握拳综合征病例未被认识到的潜在因素。对于这种罕见疾病的检查，应考虑由擅长检测周围神经卡压或损伤的手外科医生或手部治疗师进行评估。
