The S-H-A-F-T syndrome in the upper extremity.

The S-H-A-F-T syndrome is a passive form of Munchausen's syndrome in which a patient submits to multiple surgical procedures to a part of the upper extremity. Apart from the obvious connotation, the title emphasizes that the patients are sad, hostile, anxious, frustrating, and tenacious, with psychological problems similar to those of patients with Munchausen's disease--problems which are aimed at secondary gain from a psychological and/or financial nature. Three representative patients are described who had a total of 25 operations as well as multiple injections of cortisone performed by 11 doctors in five different states. Early recognition to avoid progressively mutilating operations is urged.