SHAFT syndrome revisited

Wallace aptly described patients with overriding psychological problems and upper extremity complaints as possessing the Shaft syndrome, SHAFT patient s studied fell into two categories. The first group inflicted physical harm on themselves, creating factitious injuries, The second group postured the ir limbs in attitudes that are not explainable anatomically. This latter gr oup is described by Simmons as the clenched fist syndrome. Although patient s who had factitious injuries invariably healed with protective casting, 4 patients relapsed. Eight of 14 patients who were employed at the onset of t heir complaints returned to gainful employment. Some patients received psyc hological counseling but most lacked sufficient insight to make gainful pro gress. Reaching a diagnoses was often difficult. At least 5 patients had un warranted operations. The surgeon needs a high index of suspicion when the history and findings do not match for patients harboring complaints of pain , numbness, stiffness, or inability to use their limb.