Acro-Osteolysis of the Fingers in a Spinal Cord Injury Patient

Marmolya, Gary; Yagan, Rauf; Freehafer, Alvin A.

doi:10.1097/00007632-198901000-00033

Cited by 4 publications

(3 citation statements)

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“…SIB has been described in persons with a spinal cord injury (SCI), and 2 causative models are most commonly cited, either that this SIB represented expression of anxiety or that this was a direct response to pain in the targeted body part (4)(5)(6). Neither explanation seemed appropriate in our patients.…”

Section: Introductionmentioning

confidence: 91%

Self-Inflicted Finger Injury in Individuals With Spinal Cord Injury: An Analysis of 5 Cases

Frost

Mukkamala

Covington³

2008

The Journal of Spinal Cord Medicine

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Objective: To describe the occurrence of finger autophagia in 5 persons with traumatic spinal cord injury and to present a discussion of putative causes and potential treatments. Background: Minor self-mutilating actions, such as nail biting and hair pulling, are common in humans and usually benign. In some circumstances, these behaviors are associated with obsessive-compulsive personality traits. In humans, self-injurious biting behaviors are well described in the setting of mental retardation and psychosis and in persons with Lesch-Nyhan syndrome. Rare cases of human autophagia in persons with intact cognition have been reported, most commonly in the setting of acquired nervous system lesions. After spinal cord injury, it has been suggested that this behavior constitutes a human variant of animal autotomy and a response to neuropathic pain. Design: Case presentation narrative. Main Outcome Measures: Photographic and radiological study, administration of Yale-Brown ObsessiveCompulsive Scale (YBOCS). Findings: In 5 patients with complete tetraplegia, pain in the hands was present in only one instance. The severity of autoamputation varied from minor to extreme. In all cases, damage was confined to analgesic body parts. In 3 cases, autophagia behavior was discovered in progress. Treatments included pharmacotherapy, counseling, and behavioral therapy, with mixed results. All patients were intelligent, willing to discuss their issues, and able to identify conditions of stress and isolation in their lives. Mild preinjury obsessive-compulsive behaviors, such as nail biting, were universal. On the YBOCS, only 1 patient scored in a range indicative of mild obsessive-compulsive symptomatology. Conclusions: This group exhibited heterogeneous medical, social, and cultural characteristics. A link between pain and self-injurious behavior could not be demonstrated. This behavior may be viewed as an extreme variant of nail biting, with potential ominous complications. Treatment strategies have been employed with mixed results.

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Section: Introductionmentioning

confidence: 91%

Self-Inflicted Finger Injury in Individuals With Spinal Cord Injury: An Analysis of 5 Cases

Frost

Mukkamala

Covington³

2008

The Journal of Spinal Cord Medicine

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“…1 However, self-injurious behavior has been described in individuals with mild developmental delays as well as in those with normal cognition, including three adults with spinal cord injuries (SCI). 2,3 Self-biting with multiple ®nger amputations was reported in two adult males with complete C4 SCI 2 and in another adult male with a C5-6 injury. 3 In addition, there are two published reports of self-injurious behavior in individuals with meningomyelocele.…”

mentioning

confidence: 99%

“…2,3 Self-biting with multiple ®nger amputations was reported in two adult males with complete C4 SCI 2 and in another adult male with a C5-6 injury. 3 In addition, there are two published reports of self-injurious behavior in individuals with meningomyelocele. 4,5 However, self-injurious behavior in children or adolescents with SCI has not been reported.…”

mentioning

confidence: 99%

Self-injurious behavior in children and adolescents with spinal cord injuries

2002

Spinal Cord

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Study design: A case report of self-injurious behavior in four children and adolescents with spinal cord injuries (SCI). Objectives: To report a relatively unusual complication of pediatric-onset SCI, focusing on the potential role that dysesthesia may play in self-injurious behavior. Setting: A Spinal Cord Injury Program in a Children's Hospital in Chicago that serves children from midwestern and south-central United States of America. Method: Case reports and literature review. Results: Case reports are presented of four children or adolescents with SCI who exhibited self-injurious behavior. Two of the subjects had symptoms consistent with dysesthesia. The self-injurious behavior in these two subjects and a very young child responded to treatment with anticonvulsants. The self-injurious behavior in the fourth patient was probably the result of poor technique of using his mouth to move his hands, which responded to conservative management including education, occupational therapy and gloves. Conclusion: Self-injurious behavior is a relatively unusual complication of pediatric onset SCI, and may be a manifestation of dysesthesia and be responsive to treatment with anticonvulsants.

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