Factitious disorders of the upper extremity.

Factitious disorders of the upper extremity can manifest in many different forms; therefore, it is critical to recognize warning signs in the history and examination indicating that the patient may be creating the symptoms and physical manifestations of the presenting illness. These disorders present in such predictable patterns as lymphedema, Secretan syndrome, ulcerations and wound manipulation, clenched fist, subcutaneous emphysema, pachydermodactyly, nail deformities, and self-mutilation. Management recommendations include assigning therapeutic responsibility to one person and the involvement of a multidisciplinary team. Thorough documentation is essential for the protection of both the patient and the treating physician. Treatment of patients with factitious disorders of the upper extremity requires patience and insight to avoid being manipulated into performing unnecessary surgical procedures.