Wallace aptly described patients with overriding psychological problems and upper extremity complaints as possessing the Shaft syndrome. SHAFT patients studied fell into two categories. The first group inflicted physical harm on themselves, creating factitious injuries. The second group postured their limbs in attitudes that are not explainable anatomically. This latter group is described by Simmons as the clenched fist syndrome. Although patients who had factitious injuries invariably healed with protective casting, 4 patients relapsed. Eight of 14 patients who were employed at the onset of their complaints returned to gainful employment. Some patients received psychological counseling but most lacked sufficient insight to make gainful progress. Reaching a diagnoses was often difficult. At least 5 patients had unwarranted 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.