Post-traumatic upper limb disorder and psychiatric syndrome: A case report

In this paper we describe a patient with motor-sensory loss in the right forearm and hand, which persisted more than 2 years after work-related crush trauma of the left hand. Twenty days after the trauma, a diagnosis of reflex sympathetic dystrophy syndrome was formulated. EMG showed axonal sufference at the median nerve. The patient underwent physical therapy consisting of selective mobilization of the hand and wrist and application of magnetic fields. Radiographic investigations, EMG, somatosensory evoked potentials, CT scans of the encephalus have been performed. EMG investigation showed absence of peripheral nervous lesions, a lack of voluntary activation in the opponens pollicis and abductor muscles, of the 5th finger normal sensory and motor conduction velocities in the radial, ulnar and median nerve. The somatosensory evoked potentials revealed normal latencies and amplitudes derived in Erb, C7, C3-Fz points. A CT scan of the encephalus excluded lesions in the central nervous system. We decided to perform a psychological assessment consisting of clinical colloquium, the Minnesota Multiphasic Personality Inventory and the Rorschach test. The interpretation of the MMPI's specific subscores revealed patient's imitation and conformistic attitudes and the behavioural limitations secondary to the motor deficit, as well as a high predisposition for developing sematic conversion disorders. The psychogram obtained from the Rorschach test supported the hypothesis of a posttraumatic disorder with fobic-obsessive compound. On the basis of these investigations, we think this represents a case of conversion disorder with somatic features. Included is a brief overview of other psychological illnesses with physical findings involving the upper limb.