Yumruk El Sendromu: Olgu Sunumu

Year 2022, , 97 - 101, 29.04.2022

Gülsüm Zeynep Fatma Yavuz

https://doi.org/10.47493/abantmedj.951916

Abstract

Amaç: İstirahatte nötral pozisyona dönmeyen, sabit distoninin ellerde görülen izole formu olan yumruk el sendromu (YES), fokal el distonisiyle karışabilir. Sabit distonilerin tanımlanması uzun, tedavisi zordur. Yumruk el sendromlu bir olguyu sunarak, ayırıcı tanısını ve tedavisini tariflemeyi amaçladık.

Olgu: Olgumuz YES tanısı konulan 22 yaşında erkek hasta, yaklaşık 3 aydır ilerleyici şekilde sol elini açamama ve kullanamama şikayetiyle geldi. Tramva tariflemiyor. Zamanla sol eli yumruk şekline gelmiş. EMG, servikal, pleksus ve kranial MR normal olarak değerlendirilmiş. İlaç kullanımı yoktu. Fizik muayenesinde, omuz, dirsek ve başparmak rom açıktı. Sol elin dorsalinde hafif ödem mevcuttu. Sol el parmaklar PIP eklemden, 100 derece fleksiyonda, aktif nötrale gelmiyor, pasif zorlama ile -15 derece extansiyonda kalıyor. DIP eklemler yaklaşık 50 derece fleksiyondaydı. Zorlamayla nötral pozisyona getirilebiliyor. Elde belirgin trofik değişiklik ve tırnak değişikliği, hastanın hikâyesinde ve muayenesinde hiperestezi, hiperaljezi ve allodini; ciltte ısı, renk ve terleme değişikliği yoktu. Hasta fizik tedavi programına alındı. Psikiyatrik konsültasyon istenmesini reddetti. Eklem kontraktürlerinde kısmi iyileşme gözlendi.

Sonuç: Sabit distonili hastalarda primer ve sekonder sebepler ekarte edildikten sonra tanıya ve tedaviye yönelik invazif yaklaşımlardan kaçınılmalı; içerisinde fizik tedavi uzmanı, psikiyatrist gibi uzmanların bulunduğu ekiple multidispliner yaklaşılmalıdır.

Keywords

Yumruk El Sendromu, Komplex Bölgesel Ağrı Sendromu, Sabit Distoni

Supporting Institution

Sivas Numune Hastanesi

Thanks

Hastama Olgunun Yayınlanması ve Fotoğraf Çekimine Onam Verdiği İçin Teşekkür Ederim.

Clenched Fist Syndrome: A Case Report

Abstract

Objective: Clenched fist syndrome, an isolated form of fixed dystonia in the hands that does not return to the neutral position at rest, is a long-term, difficult-to-treat condition that can be confused with focal hand dystonia. We aimed to describe the differential diagnosis and treatment of a case with celenched fist syndrome.

Case: Our case, a 22-year-old male patient diagnosed with Clenched fist syndrome, presented with the complaint of progressive inability to open and use his left hand for about 3 months. The tram did not describe. Over time, his left hand turned into a fist. Electromyography, cervical, plexus and cranial magnetic resonance imaging were evaluated as normal. There was no drug use. On physical examination, shoulder, elbow and thumb joint ranges of motion were normal. There was mild edema in the dorsal aspect of the left hand. Left hand fingers from proximal interpharyngeal joint, 100 degrees of flexion, do not actively neutralize, remain in -15 degrees extension with passive force. The distal interpharyngeal joints were approximately 50 degrees of flexion. It could be forced into neutral position. No significant trophic changes and nail changes were observed in the hand. Hyperesthesia, hyperalgesia and allodynia in the patient's history and examination; There was no change in temperature, color or sweating on the skin. The patient was included in the physical therapy program. He refused to be asked for psychiatric consultation. Partial improvement was observed in joint contractures after treatment.

Conclusion: In patients with fixed dystonia, invasive approaches for diagnosis and treatment should be avoided after primary and secondary causes are ruled out; A multidisciplinary approach should be made with a team of specialists such as physical therapists and psychiatrists.

References

• 1. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004;127:2360- 2372.
• 2. Cordivari C, Misra VP, Catania S, Lees AJ. Treatment of dystonic clenched fist with botulinum toxin. Mov Disord 2001;16:907-913.
• 3. Taşçılar N, Ekem S, Başaran A, Özdolap Ş. Clenched Fist Syndrome; an Isolated Fixed Dystonia: A Case Report and Review of the Literature.Türk Nöroloji Dergisi 2008;344-349
• 4. Harden RN, Bruehl SP. Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain 2006;22:415-419.
• 5. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007;8:326-331.
• 6. DW, Walker SE. The clenched fist syndrome. A psychiatric syndrome mimicking reflex sympathetic dystrophy. Arthritis Rheum 1995;38:57-60.
• 7. Louis DS, Lamp MK, Greene TL. The Upper extremity and psychiatric illness. J Hand Surg [Am] 1985;10:687-693
• 8. Balakrishnan C, Bradt LM, Sylora RL, Kavali CM. Hand infection associated with clenched fist syndrome in residents of long-term care facilities. J Psychosoc Nurs Ment Health Serv 2002;40:16-19.
• 9. Graham WP, Shearer AW, Mackay DR, Santo J, Stratis JP. SHAFT syndrome revisited. Ann Plast Surg 1999;42:411-417.