Orthopaedic variant of Munchausen's Syndrome: shoulder instability

Abstract

In 1951 the physician Richard Asher described a syndrome in which patients travelled widely and told tall tales, feigning illness in order to obtain hospital admission, treatment with opiates or general anaesthetics or surgical operation. They differed from simple malingerers because their motivation for such behaviour remained obscure [1]. Asher named the condition Munchausen’s Syndrome, in honour of Baron von Munchausen, a much travelled adventurer of legend who told enormously implausible tales [2]. Since Dr Asher was something of an anti-establishment figure, he was particularly inspired by von Munchausen’s tale of raising the College of Physicians of London into the air by balloon for 3 months (during which time the health of its patients was never better). The syndrome is therefore unique in being derived in part from a private joke. Nevertheless, it has spread, through English language medical literature, to being a substantive diagnosis in Europe, North America, Australasia and the Middle East. Only in the USA is the alternative label of pathological lying or pseudologico fantistico [3] still occasionally used. Richard Asher divided his new syndrome into three distinct variants, i.e. 1. The acute abdominal type, laparotomophilia migrans, which is the most common type. 2. Factitious haemorrhage. 3. The neurological type, sometimes called neuropathia diabolica. It is type (a) which concerns us here. When sternotomies became common, they vied with laparotomies as index-scars of this condition. In this article, I define a further, and previously undescribed group of patients who present with chronic shoulder instability, even after surgery to correct this problem, and who accordingly present with an axillary index-scar.