Faculty Collaboration Database

Factitious hand disorders: review of 29 years of multidisciplinary care. J Hand Surg Am 2013 Aug;38(8):1590-8

Date

07/31/2013

Pubmed ID

23890498

DOI

10.1016/j.jhsa.2013.04.047

Scopus ID

2-s2.0-84880866008 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

PURPOSE: To improve our understanding of factitious hand disorders with a review of our experience over 29 years in a multidisciplinary hand center.

METHODS: A retrospective chart review was performed to identify workers' compensation patients treated for factitious hand disorders in the multidisciplinary hand center between January 1981 and September 2010. Multidisciplinary evaluation at this center involved evaluation by hand surgeons, occupational therapists, and psychologists. Data collected include age, sex, race, educational level, clinical presentation, number of diagnostic tests, number of surgeries, time to referral to the multidisciplinary center, direct cost of care, psychological diagnosis, Minnesota Multiphasic Personality Inventory, treatment modalities, and work status.

RESULTS: We identified 174 workers' compensation patients with factitious hand disorders. Presentation was used to classify patients into 1 of 4 categories: psychopathological dystonia, factitious edema, psychopathological complex regional pain syndrome, and factitious wound creation and manipulation. There were statistically significant differences between the 4 categories in demographics, utilization of medical resources, psychopathology, treatment modalities, and return-to-work status. Patients with factitious wounds were more educated, used more medical resources, demonstrated an angry or hostile profile, and experienced a lower return-to-work rate. Patients with dystonia were less educated, used less medical resources, demonstrated a hypochondriasis or depressed profile, and experienced a higher return-to-work rate.

CONCLUSIONS: Treatment of factitious hand disorders remains frustrating and costly due to failure or recurrence after traditional approaches. This review is a large-scale examination of the factitious hand disorder population that demonstrates the unique pathology involved in each of the 4 categories. There is a specific association between the category of hand disorder and the underlying pathology and prognosis.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Author List

O'Connor EA, Grunert BK, Matloub HS, Eldridge MP

Authors

Brad K. Grunert PhD Professor in the Plastic Surgery department at Medical College of Wisconsin
Hani S. Matloub MD Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Accidents, Occupational
Adult
Age Distribution
Cohort Studies
Factitious Disorders
Female
Hand Injuries
Health Care Costs
Humans
Incidence
Male
Middle Aged
Physician-Patient Relations
Prognosis
Referral and Consultation
Retrospective Studies
Return to Work
Risk Assessment
Self Mutilation
Sex Distribution
Workers' Compensation