Waddell's signs

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Waddell's signs are a group of physical signs, first described by Waddell et al in 1980,[1] that may indicate non-organic or psychological component to chronic low back pain. Historically they have been used to detect "malingering" patients with back pain.

[edit] Use of Waddell's Signs

One or two Waddell's signs can often be found even when there is not a strong non-organic component to pain. Three or more are positively correlated with high scores for depression, hysteria and hypochondriasis on the Minnesota Multiphasic Personality Inventory.

Waddell's signs are:

  1. Superficial tenderness – skin discomfort on light palpation.
  2. Nonanatomic tenderness – tenderness crossing multiple anatomic boundaries.
  3. Axial loading – eliciting pain when pressing down on the top of the patient’s head.
  4. Pain on simulated rotation - rotating the shoulders and pelvis together should not be painful as it does not stretch the structures of the back.
  5. Distracted straight leg raise - if a patient complains of pain on straight leg raise, but not if the examiner extends the knee with the patient seated (e.g. when checking the Babinski reflex).
  6. Regional sensory change - Stocking sensory loss, or sensory loss in an entire extremity or side of the body.
  7. Regional weakness - Weakness that is jerky, with intermittent resistance (such as cogwheeling, or catching). Organic weakness can be overpowered smoothly.
  8. Overreaction - Exaggerated painful response to a stimulus, that is not reproduced when the same stimulus is given later.

Although Waddell's signs can detect a non-organic component to pain, they do not exclude an organic cause. A high Waddell score (>3) is indicative only of symptom magnification or possible illness behavior. Often the test has been misused.[citation needed] It does not signify malingering.

According to an original article the actual numbers of Waddell's signs are 5: (Waddell G, McCulloch HA, Kummel E, Venner RM. Non-organic physical signs in low-back pain. Spine 1980; 5: 117-25)

  • 1. Superficial and Widespread tenderness or Nonanatomic tenderness. (It's "one" sign)
  • 2. Stimulation tests: Axial loading and Pain on simulated rotation. (It's another "one" sign)
  • 3. Distracted straight leg raise.
  • 4. Non-anatomic sensory changes: Regional sensory changes and Regional weakness.(It's another "one" sign)
  • 5. Overreaction.

If there are more than 3 of 5 present then there is high probability that patient has non-organic pain.

[edit] External links

[edit] References

  1. ^ Waddell G, McCulloch JA, Kummel E, Venner RM (1980). "Nonorganic physical signs in low-back pain". Spine 5: 117–25. doi:10.1097/00007632-198003000-00005. PMID 6446157.