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Flashcards in Waddell's Signs Deck (15)
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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?

- Painful
- Emotional
- Surprising


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


What are 2 indications of psychosocial problems from a PACT-sort questionairre?

- "I don't know"s
- Disparity between job description and PACT-sort score