PSYCHOSOMATIC PROBLEMS IN MILITARY ORTHOPAEDIC SURGERY

¹ Orthopaedic Section Army Air Forces Regional Hospital, Santa Ana Army Air Base, Santa Ana, California

1. There is a psychiatric aspect to orthopaedic surgery which should receive increased recognition.

2. A psyychosomatic diagnosis must be made on the basis of positive findings, and not alone by exclud!ing organic entities.

3. Psychogenic musculoskeletal symptoms were found in 11.1 per cent. of the patients hospitalized in the Orthopaedic Section. Among patients in the Orthopaedic Out-Patient Department, the incidence of psychological desorders was over 25 per cent. Approximately 1,000 Patients with psychogenic musculoskeletal symptoms were studied.

4. Based upon the relationship to organic symptoms, three types of psychological problems were observed: (1) those occurring without known relationship to an organic lesion; (2) those secondary to and accompanying an organic lesioin; an (3) those perpetuating symptoms of a heales organic lesion. Based upon psychiatric symptoms, the types seen were: (1) conversion reactions, (2) anxiety states, and (3) psychogenic elaboration of organic symptoms.

5. An abbreviated psychological history was obtained from all patients in whom the source of symptoms was obscure and the objective findings were bizarre.

6. Musculoskeletal pains of uncertain origin should be analyzed in terms of their exact character. Neurotic pains frequently include a sense of pressure, tension, or numbness. Bizarre radiating pains, particularly those radiating from a distal point proximally, are often psychogenic. Psychogenic and organic musculoskeletal symptoms are compared.

7. There may be several objective findings to identify a neurosis, or there may be none. The findings most often encountered include circumferential hypalgesia, hysterical paralysis, coarse intention tremors, and anxiety symptoms.

8. In 100 consecutive cases in which conversion reactions included circumferential hypalgesia, the patterns of hypalgesia are presented. Ten of the 100 patients had hysterical paralysis.

9. Sites of neurotic musculoskeletal symptoms are listed, together with some of the factors determining these sites.

10. The scope and use of superficial psychotherapy are discussed.

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