Waddell's Signs

Question 1

What are Waddell’s 5 signs?

Answer 1

• 5 types of physical signs to indicate a heavy psychosocial overlay to patient’s symptoms

Question 2

If a patient has positive 3 or more types of Waddell’s signs, what is the next step?

Answer 2

• They may require additional psychological assessment

Question 3

In what 2 settings are Waddell’s signs especially important?

Answer 3

• Patients with spinal injury

- Patients involved in worker’s compensation

Question 4

How many Waddell’s signs summate in a clinically significant finding?

Answer 4

• 3 or more TYPES

Question 5

What is the tenderness sign?

Answer 5

• 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

Question 6

What are stimulation tests?

Answer 6

• They give the impression that an examination is being done when one is not

Question 7

What are 2 simulation tests?

Answer 7

• 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

Question 8

What is a distraction test?

Answer 8

• Reevaluating a positive finding while the patient’s attention is not focused on the test

Question 9

What 3 things must the distraction not be?

Answer 9

• Painful
• Emotional
• Surprising

Question 10

What are 2 methods of distraction>?

Answer 10

• 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

Question 11

What are regional disturbances?

Answer 11

• Widespread divergence from accepted neuroanatomy

Question 12

What are 2 examples of regional disturbances?

Answer 12

• weakness: “cogwheeling” (clicking, twitchy resistance) or muscle weakness that can’t be explained neuroanatomically
• sensory: “stocking” distribution of sensory changes
  (No findings on imaging)

Question 13

What is overreaction?

Answer 13

• Disproportionate verbalization, facial expression, mescle tension and tremor, collapsing, seating to light palpation, or low resistance

Question 14

Why is overreaction the most difficult sign to assess?

Answer 14

• Cultural variation

- Examiner bias

Question 15

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

Answer 15

• “I don’t know”s

- Disparity between job description and PACT-sort score