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Psychosocial Factors in Patients diagnosed with Saddle Syndrome of the Hand
Shailee Shah, BS1; Abdo Bachoura, MD2; Sidney M. Jacoby, MD1; Brian George, MD1; Randall W. Culp, MD2;
1Thomas Jefferson University, 2Philadelphia Hand Center

Introduction: Saddle syndrome of the hand is a controversial syndrome and is defined as hand pain at the level of the metacarpal head secondary to the development of post-traumatic adhesions between the interosseous and lumbrical muscles. This causes impingement on the deep transverse metacarpal ligament, and eventually leads to pain. The diagnosis is usually based on a clinical exam and it is often a diagnosis of exclusion. We set out to investigate the psychosocial characteristics of patients who have been diagnosed with saddle syndrome.

Materials & Methods: The medical records of patients diagnosed with saddle syndrome of the hand at one center between 1/1/2000 and 12/1/2011 were reviewed. In all cases, the diagnosis was made by one experienced hand surgeon who applied the "saddle test". Any patients who were diagnosed with saddle syndrome and subsequently found to have an organic pathology such as a fracture, bone bruising or ligament tear were excluded (n=7). Patients under the age of 18 were excluded. Demographic data, diagnostic method, treatment modality, associated illness, associated psychological or psychiatric conditions, medications at time of diagnosis, and workers compensations status were collected.

Results: There were 27 patients with a mean age of 44 years (range 19-79). There were 17 females and 10 males. In all cases the diagnosis was based on a clinical exam, including a positive "saddle sign". There was no evidence of any pathology on x-rays, MRI, EMG or bone scan. Of the 27 patients, 7 (26%) were taking anxiolytics (n=6) and/or anti-depressants (n=4) at the time of diagnosis. Seven patients (26%) had workman's compensation claims at the time of diagnosis, 1 of which was also taking anxiety/depression medications. Six patients underwent surgery for release of adhesions, 20 patients were treated conservatively either by steroid injection, therapy or splinting and one patient did not have any treatment.

Conclusion: Saddle syndrome is a controversial musculoskeletal pain syndrome, and has the classical findings associated with other functional somatic syndromes including a higher prevalence in females, psychological distress and is a diagnosis of exclusion. Furthermore, we have noticed that a relatively high proportion of our patients had workman's claims, which raises questions about the intentions of these patients with regard to compensation. The biopsychosocial aspects of patients with saddle syndrome need to be further studied to determine the underlying factors involved in the etiology. This may help in the development of a more systematic treatment approach.

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