Patients Presenting With a Clenched Fist: A Perspective From an Electrodiagnostic Laboratory

A clenched fist is a clinical sign that may have diverse etiologies, including certain psychiatric and neurological disorders, or may occur after localized trauma. The clenched fist may be partial or complete and is usually unilateral. Our objective was to determine the etiology of a clenched fist in a cohort of patients.

This is a retrospective analysis of 17 patients who were referred to our Neurodiagnostic Center for evaluation of a clenched fist over an 18.5-year period (January 1, 2008, to June 30, 2026). All patients underwent a clinical examination followed by electrodiagnostic studies, which included nerve conduction and needle electromyography (EMG), to determine the presence of neuromuscular disorders.

Of the 17 patients who presented with a clenched fist, it was unilateral in 16 (94.1%) and bilateral in 1 (5.9%). Four (23.5%) patients had an underlying neurological disorder (Lewy body dementia, corticobasal degeneration, spastic dystonic hand due to a contralateral frontal lobe lesion), and one had tendinopathy. In 13 (76.5%) patients, no specific cause could be found. Most patients in the latter category either sustained a recent injury and/or surgery in the ipsilateral upper extremity with the clenched fist and/or had an extensive psychiatric history. The clenched fist was partial in 11 (64.7%) patients and complete in 6 (35.3%).

It is important to be aware that a clenched fist could be a manifestation of not only psychiatric conditions but also a neurological disorder. A multidisciplinary approach involving neurologists, hand surgeons, neurosurgeons, and psychiatrists is necessary for the diagnosis and management of a clenched fist. Determining the accurate etiology of the clenched fist in a timely manner may expedite appropriate treatment.