In the surgical hand clinic, psychopathological hand disorders can be sorted into one of the following four categories: (1) factitious wound creation and manipulation; (2) factitious edema; (3) psychopathological dystonias, and (4) psychopathological sensory abnormalities and psychopathological Complex Regional Pain Syndrome. This article introduces these four categories. Pertinent literature that includes descriptions of each category's syndromes and diseases, demographic and psychological profiles, differential diagnoses, and appropriate treatment recommendations is reviewed.
Al-QattanMM. Factitious disorders of the upper limb in Saudi Arabia. J Hand Surg [Br]2001;26:414–21.
4.
AlbrechtPJHinesSEisenbergE. Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome. Pain2006;120:244.
5.
AmadioPC. Pain dysfunction syndromes. J Bone Joint Surg Am1988;70:944–9.
BarnertC. Conversion reactions and psychophysiologic disorders: a comparative study. Psychiatry Med1971;2:205–20.
8.
BinzerMKullgrenG. Motor conversion disorder: A prospective 2- to 5-year follow-up study. Psychosomatics1998;39:519–27.
9.
CardenNLSchamelDJ. Observations of conversion reactions seen in troops involved in the Viet Nam conflict. Am J Psychiatry1966;123:21–31.
10.
CarneyMW. Artefactual illness to attract medical attention. Br J Psychiatry1980;136:542–7.
11.
CassadyJDKirschkeDLJonesTF. Case series: outbreak of conversion disorder among Amish adolescent girls. J Am Acad Child Adolesc Psychiatry2005;44:291–7.
Ciano-FederoffLMSperryJA. On “converting” hand pain into psychological pain: treating hand pain vicariously through exposure-based therapy for. PTSD.2005;4:57–71.
14.
CrabtreeLHJr. A psychotherapeutic encounter with a self-mutilating patient. Psychiatry1967;30:91–100.
15.
CramerBGershbergMRSternM. Munchausen syndrome. Its relationship to malingering, hysteria, and the physician–patient relationship. Arch Gen Psychiatry1971;24:573–8.
16.
CrimliskHLBhatiaKCopeH. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ (Int Ed)1998;316:582–6.
17.
de FontaineSVan GeertruydenJPreud'hommeX. Munchausen syndrome. Ann Plast Surg2001;46:153–8.
18.
DickesRA. Brief therapy of conversion reactions: an in-hospital technique. Am J Psychiatry1974;131:584–6.
DriessensMDijsHVerheyenG. What is reflex sympathetic dystrophy?Acta Orthop Belg1999;65:202–17.
21.
DrinkerHKnorrNJEdgertonMTJr. Factitious wounds. A psychiatric and surgical dilemma. Plast Reconstr Surg1972;50: 458–61.
22.
FishbainDAGoldbergMMeagherBR. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain1986;26:181–97.
23.
FolksDGFordCVReganWM. Conversion symptoms in a general hospital. Psychosomatics1984;25:285–9.
24.
FordCV. The somatizing disorders. Psychosomatics1986;27: 327–31.
25.
FriedmanBYaffeBBlanksteinA. Self inflicted hand injuries: diagnostic challenge and treatment. Ann Plast Surg1988;20:345–9.
26.
FrykmanGKWoodVEMillerEB. The psycho-flexed hand. Clin Orthop Relat Res1983;174:153.
27.
GalinDDiamondRBraffD. Laterlization of conversion symptoms: more frequent on the left. Am J Psychiatry1977;134 :578–80.
28.
GouldRMillerBLGoldbergMA. The validity of hysterical signs and symptoms. J Nerv Ment Dis1986;174:593–7.
29.
GrahamWP3rdShearerAWMackayDR. SHAFT syndrome revisited. Ann Plast Surg1999;42:411–6; discussion 416–7.
30.
GreippMEThomasAF. Skin lesions occurring in clients with reflex sympathetic dystrophy syndrome. J Neurosci Nurs1994;26 :342–6.
31.
GrunertBKDevineCASangerJR. Thermal self-regulation for pain control in reflex sympathetic dystrophy syndrome. J Hand Surg [Am]1990;15:615–8.
32.
GrunertBKSangerJRMatloubHS. Classification system for factitious syndromes in the hand with implications for treatment. J Hand Surg [Am]1991;16:1027–30.
33.
HafeizHB. Hysterical conversion: a prognostic study. Br J Psychiatry1980;136:548–51.
34.
HendlerN. Skin lesions occurring in clients with reflex sympathetic dystrophy syndrome. J Neurosci Nurs1995;27 :206.
35.
HerutiRJLevyAAdunskiA. Conversion motor paralysis disorder: overview and rehabilitation model. Spinal Cord2002;40 :327–34.
36.
HerutiRJReznikJAdunskiA. Conversion motor paralysis disorder: analysis of 34 consecutive referrals. Spinal Cord2002;40:335–40.
37.
HoningMLKonM. Dysfunctional postures of the hand as part of a conversion reaction. J Hand Surg [Br]1996;21: 271–5.
38.
JaworowskiSAllenRCFinkelsteinE. Reflex sympathetic dystrophy in a 12-year-old twin with comorbid conversion disorder in both twins. J Paediatr Child Health1998;34: 581–3.
39.
JustusPGKreutzigerSSKitchensCS. Probing the dynamics of Munchausen's syndrome. Detailed analysis of a case. Ann Intern Med1980;93:120–7.
40.
KasdanMLSoergelTMJohnsonAL. Expanded profile of the SHAFT syndrome. J Hand Surg [Am]1998;23:26.
41.
KimballCPBlindtK. Some thoughts on conversion. Psychosomatics1982;23:647–49.
42.
KnorrNJEdgertonMTHoopesJE. The “insatiable” cosmetic surgery patient. Plast Reconstr Surg1967;40:285–9.
43.
KoelmanJHHilgevoordAABourLJ. Soleus H-reflex tests in causalgia–dystonia compared with dystonia and mimicked dystonic posture. Neurology1999;53:2196–8.
44.
KomanLASmithTLSmithBP. The painful hand. Hand Clin1996;12:757–64.
45.
KramerKKLa PianaFGAppletonB. Ocular malingering and hysteria: diagnosis and management. Surv Ophthalmol1979;24: 89–96.
46.
LazareA. Current concepts in psychiatry. Conversion symptoms. N Engl J Med1981;305:745–8.
47.
LouisDSJebsonPJ. Mimickers of hand infections. Hand Clin1998;14:519–29.
48.
LyellA. Cutaneous artifactual disease. A review, amplified by personal experience. J Am Acad Dermatol1979;1:391–407.
49.
MaceCJTrimbleMR. Ten-year prognosis of conversion disorder. Br J Psychiatry1996;169:282–8.
50.
MaillardSMDaviesKKhubchandaniR. Reflex sympathetic dystrophy: a multidisciplinary approach. Arthritis Rheum2004;51:284–90.
51.
MallottIFEarleyLWWhiteWL. Psychic disturbances and wound healing. Plast Reconstr Surg1958;21:272–8.
52.
MaloneyMJ. Diagnosing hysterical conversion reactions in children. J Pediatr1980;97:1016–20.
53.
MannionSJMehtaJSSpencerJD. Oedeme bleu. J R Soc Med1998;91:491–2.
54.
MassonCAudranMPascarettiC. Different patterns of extension and recurrence in algodystrophy. Acta Orthop Belg1998;64:71–6.
55.
McDonoughJJ. Classification system for factitious syndromes in the hand. J Hand Surg [Am]1992;17:976.
56.
McKegneyFP. The incidence and characteristics of patients with conversion reactions. I. A general hospital consultation service sample. Am J Psychiatry1967;124:542–5.
57.
MitchellWM. Self-insertion of urethral foreign bodies. Psychiatr Q1968;42:479–86.
MoseleyGL. Imagined movements cause pain and swelling in a patient with complex regional pain syndrome. Neurology2004;62 :1644.
60.
OaklanderALRissmillerJGGelmanLB. Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy). Pain2006;120:235.
61.
OberfieldRAReubenRNBurkesLJ. Interdisciplinary approach to conversion disorders in adolescent girls. Psychosomatics1983;24:983–9.
62.
OrensteinAFriedmanBYaffeB. Factitious lymphedema of the hand: a diagnostic challenge. Cutis1987;39:427–8.
63.
ParisodEMurrayRFCousinsMJ. Conversion disorder after implant of a spinal cord stimulator in a patient with a complex regional pain syndrome. Anesth Analg2003;96:201–6.
64.
ReadingG. Secretan's syndrome: hard edema of the dorsum of the hand. Plast Reconstr Surg1980;65:182.
65.
ReesTDDanillerA. Self-mutilation: some problems in reconstruction. Plast Reconstr Surg1969;43:300–3.
66.
ReichPGottfriedLA. Factitious disorders in a teaching hospital. Ann Intern Med1983;99:240–7.
67.
Rodriguez-MorenoJRuiz-MartinJMMateo-SoriaL. Munchausen's syndrome simulating reflex sympathetic dystrophy. Ann Rheum Dis1990;49:1010–2.
68.
RoelofsKNaringGWMoeneFC. The question of symptom lateralization in conversion disorder. J Psychosom Res2000;49:21–5.
69.
SaferinEHPoschJL. Secretan's disease: post-traumatic hard edema of the dorsum of the hand. Plast Reconstr Surg1976;58:703–7.
70.
SennwaldG. Expanded profile of SHAFT Syndrome. J Hand Surg [Am]1998;23A:1118–9.
71.
SerafinDDimondMFranceR. Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment. Plast Reconstr Surg1983;72:81–9.
72.
SimmonsBVasileR. The clenched fist syndrome. J Hand Surg [Am]1980;5:420–4.
73.
SinghHPDavisTR. The effect of short-term dependency and immobility on skin temperature and colour in the hand. J Hand Surg [Br]2006;31:611–5.
74.
SmithRJ. Factitious lymphedema of the hand. J Bone Joint Surg Am1975;57:89–94.
75.
SpiroHR. Chronic factitious illness. Munchausen's syndrome. Arch Gen Psychiatry1968;18:569–79.
76.
Stanton-HicksMJanigWHassenbuschS. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain1995;63:127–33.
77.
StefanisCMarkidisMChristodoulouG. Observations on the evolution of the hysterical symptomatology. Br J Psychiatry1976;128:269–75.
78.
SternDB. Handedness and the lateral distribution of conversion reactions. J Nerv Ment Dis1977;164:122–8.
79.
StevensH. Conversion hysteria: a neurologic emergency. Mayo Clin Proc1968;43:54–64.
80.
StinnettJL. The functional somatic symptom. Psychiatr Clin North Am1987;10:19–33.
StoneJSharpeMCarsonA. Are functional motor and sensory symptoms really more frequent on the left? A systematic review. J Neurol Neurosurg Psychiatry2002;73:578–81.
83.
StoneJSharpeMRothwellPM. The 12 year prognosis of unilateral functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry2003;74:591–6.
84.
StoneJCarsonASharpeM. Functional symptoms in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry2005;76Suppl 1:i2–12.
StoneJSmythRCarsonA. Systematic review of misdiagnosis of conversion symptoms and “hysteria”. BMJ (Int Ed)2005;331:989–94.
87.
StoneJSmythRCarsonA. La belle indifference in conversion symptoms and hysteria: systematic review. Br J Psychiatry2006;188:204–9.
88.
SutherlandAJRodinGM. Factitious disorders in a general hospital setting: clinical features and a review of the literature. Psychosomatics1990;31:392–9.
89.
SwiftDWWalkerSE. The clenched fist syndrome. A psychiatric syndrome mimicking reflex sympathetic dystrophy. Arthritis Rheum1995;38:57–60.
90.
VerdugoRJOchoaJL. Abnormal movements in complex regional pain syndrome: assessment of their nature. Muscle Nerve2000;23:198–205.
91.
VerdugoRJBellLACamperoM. Spectrum of cutaneous hyperalgesias/allodynias in neuropathic pain patients. Acta Neurol Scand2004;110:368–76.
92.
WallacePFFitzmorrisCSJ. The S-H-A-F-T syndrome in the upper extremity. J Hand Surg [Am].1978;3:492–4.
93.
WeddingtonWWJr. Conversion reaction in an 82-year-old man. J Nerv Ment Dis1979;167:368–9.
94.
WeinsteinEAEckRALyerlyOG. Conversion hysteria in Appalachia. Psychiatry1969;32:334–41.
95.
WeintraubMIHysteria. A clinical guide to diagnosis. Clin Symp1977;29:1–31.
96.
Wemyss-GormanPB. Munchausen's syndrome and chronic pain. Hosp Med1998;59:738.
97.
WhitneyTMJonesNF. Magnetic resonance imaging findings in Secretan's disease. J Hand Surg [Am]1995;20:464.
98.
WithringtonRHWynn ParryCB. Rehabilitation of conversion paralysis. J Bone Joint Surg Br1985;67:635–7.
99.
WoodruffRAJr.ClaytonPJGuzeSB. Hysteria: an evaluation of specific diagnostic criteria by the study of randomly selected psychiatric clinic patients. Br J Psychiatry1969;115:1243–8.
100.
YarnitskyDSprecherETamirA. Variance of sensory threshold measurements: discrimination of feigners from trustworthy performers. J Neurol Sci1994;125:186–9.
101.
YoungLDHarschHH. Factitious illness v conversion disorder. JAMA1983;249:3304–5.
102.
ZylukA. Scoring system in the assessment of the clinical severity of reflex sympathetic dystrophy of the hand. Hand Clin2003;19:517–21.
