ROBERT DENNIS, M.D., F.A.A.O.S., C.I.M.E.

Board Certified Orthopaedic Surgeon | Board Certified Independent Medical Examiner | Forensic Orthopaedic Specialist

     
         

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Preview:
Distinguishing behavior from organic problems is a frequent challenge for physicians.
Listed below are eight signs that were developed by Waddell and colleagues.
  • Superficial Tenderness
  • Non-anatomic Tenderness
  • Axial Loading
  • Simulated Rotation
  • Distracted Straight-Leg Raise
  • Regional Sensory Change
  • Regional Weakness
  • Overreaction

In addition to the eight Waddell signs, Dr. Dennis has incorporated some of his own signs based on his experience:

  1. Simple instructions are not easily understood (apparent confusion). "Raise your toes against me" causes the reverse.
  2. Observation of simple activities, such as taking off a jacket or shirt demonstrates excellent range of motion of shoulders and neck while testing of these areas are individually demonstrating a dramatic limitation of the specific areas.
  3. Observation of the Examinee entering the office and exam room compared to the Examinee being asked to perform the same activity under direct observation; (Stand, walk, sit, etc.)
  4. Maintaining eye contact during introductory conversation. The doctor notes the ease of use of the neck when he purposely speaks to the Examinee from his right and then his left.
  5. Hoover Test: muscle spasms or their absence. Other classic tests.
  6. The opposite of an antalgic gait. Where more time is spent on the defective leg than less, during Gait Analysis.
  7. "Everything Hurts": Even to light touch.
  8. Distribution or radiation of subjective pain, follows No known neurologic path.
  9. Jerky motions when asked to contract a muscle group against resistance. as if The Examinee can't decide how strong he/she should be.

No one technique is 100%. One must be cautioned against over dependence on these signs, but it is important for a physician (whether a treating physician or an examining physician) to be aware and sensitized to patients who present with malingering or magnifying of their symptoms for purposes of secondary gain.

Most physicians resent being lied to, abused or involuntarily used as part of a conspiracy. The application of this knowledge serves to protect not only the physician, but also all parties concerned.

 
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