Waddell's signs

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'Waddells signs' are a group of physical signs, first described by Waddell et al'' in 1980, 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.

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:# Superficial tenderness – skin discomfort on light palpation.
    # Nonanatomic tenderness – tenderness crossing multiple anatomic boundaries. # Axial loading – eliciting pain when pressing down on the top of the patient’s head. # Pain on simulated rotation - rotating the shoulders and pelvis together should not be painful as it does not stretch the structures of the back. # 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). # Regional sensory change - Stocking sensory loss, or sensory loss in an entire extremity or side of the body. # Regional weakness - Weakness that is jerky, with intermittent resistance (such as cogwheeling, or catching). Organic weakness can be overpowered smoothly. # 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. 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.

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