Flashcards in Waddell's Signs Deck (15)
What are Waddell's 5 signs?
- 5 types of physical signs to indicate a heavy psychosocial overlay to patient's symptoms
If a patient has positive 3 or more types of Waddell's signs, what is the next step?
- They may require additional psychological assessment
In what 2 settings are Waddell's signs especially important?
- Patients with spinal injury
- Patients involved in worker's compensation
How many Waddell's signs summate in a clinically significant finding?
- 3 or more TYPES
What is the tenderness sign?
- Superficial: Skin is tender to light pinch over a wide area of lumbar skin
- Non-anatomic: Deep tenderness over a wide area, not localized to one structure
- Can extend into the T-spine, sacrum, or pelvis
What are stimulation tests?
- They give the impression that an examination is being done when one is not
What are 2 simulation tests?
- Axial load: Vertical loading over the patient's skull in standing; May cause neck pain, but should not cause back pain
- Rotation: Turn a standing patient to one side by rotating the lower extremities, and keeping a straight spine
What is a distraction test?
- Reevaluating a positive finding while the patient's attention is not focused on the test
What 3 things must the distraction not be?
What are 2 methods of distraction>?
- Indirect observation: Does the patient move the joint normally when it is not being examined
- SLR: If positive in supine, check again by performing the babinski sign in sitting
What are regional disturbances?
- Widespread divergence from accepted neuroanatomy
What are 2 examples of regional disturbances?
- weakness: "cogwheeling" (clicking, twitchy resistance) or muscle weakness that can't be explained neuroanatomically
- sensory: "stocking" distribution of sensory changes
(No findings on imaging)
What is overreaction?
- Disproportionate verbalization, facial expression, mescle tension and tremor, collapsing, seating to light palpation, or low resistance
Why is overreaction the most difficult sign to assess?
- Cultural variation
- Examiner bias