Waddells Signs

Other Names

• Wadell Signs
• Waddell's Sign

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Purpose

• Initially designed to identify patients with low back pain who were likely to experience a poor surgical outcome from lower back surgery
• More recently used detect psychogenic, sometimes inappropriately labeled “non-organic,” manifestations of low back pain in patients
• Used to identify malingering in patients

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Description

• Superficial and Widespread tenderness or Nonanatomic tenderness
  • The patient’s skin over a wide area of the lumbar skin is tender to light touch or pinch which does not follow an anatomical boundary
• Axial Loading
  • Downward pressure on the top of the patient’s head elicits lumbar pain. This should not be painful
• Acetabular Rotation
  • Lumbar pain is elicited while the provider passively and simultaneously externally rotates the patient’s shoulder and pelvis together in the same plane as the patient stands. Rotating the shoulders and pelvis together should not be painful
• Distracted straight leg raise discrepancy
  • The patient complains of pain during a supine straight leg raise during formal testing but the test is negative when the patient is distracted or in a seated position
• Regional sensory disturbance
  • The patient experiences decreased sensation that does not follow a dermatomal or anatomic pattern
• Regional weakness
  • Weakness, cogwheeling, or the giving way of many muscle groups that are not explained on a neuroanatomical basis.
• Overreaction
  • Exaggerated painful response to a stimulus, that is not reproduced when the same stimulus is given later. These responses can include verbalization, facial expression, muscle tension, or tremor.

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Pathology

• Non-Organic Back Pain

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Evidence

• Unknown

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See Also

• Back Pain Main
• Physical Exam Back

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