Revisiting psychopathological hand as a functional neurological disorder: Time to reframe?

The "psychopathological hand" or "psychogenic hand", long regarded as a clinical curiosity, remains underdiagnosed today and is sometimes confused with other hand conditions. The aim of this article is to reframe the psychopathological hand syndrome within the field of functional neurological disorders, in order to clarify its clinical, pathophysiological and therapeutic specificities.

A narrative review of the literature was conducted using international medical databases and reference works in functional neurology, psychiatry and hand surgery. The main data were synthesized along four axes: historical aspects, diagnostic and clinical criteria, comorbidities and pathophysiological models, therapeutic strategies and organization of care.

Functional neurological disorders of the hand are characterized by anatomo-clinical inconsistencies, symptom variability, and frequent presentations such as functional dystonias, tremors, paresis or atypical pain. They occur in a context of vulnerability due to early trauma, heightened bodily vigilance, and psychiatric or somatic comorbidities. From a neurofunctional perspective, they reflect a disorganization of the networks of agency, interoception and emotion. Treatment is based on a positive diagnosis announcement, recovery by combined action, psychotherapeutic support and multidisciplinary coordination.

The psychopathological hand constitutes a localized manifestation of a functional neurological disorder and should no longer be regarded as a marginal entity. Its recognition as a specific functional disorder helps to avoid inappropriate treatments and paves the way for integrated care strategies and a better structuring of specialized pathways.