Spine Orthopaedic Test: Waddell Sign

The Waddell Test is a diagnostic assessment that can be used to evaluate the presence of non-organic or psychogenic signs of low back pain.

Here are the steps to perform the Waddell Test:

• Begin by instructing the patient to sit on a firm surface with their hands resting on their thighs.
• Instruct the patient to relax and maintain a neutral posture.
• Apply a series of six tests that provoke a response that is more likely to be non-organic or psychogenic in nature rather than related to an actual structural abnormality. The tests include:

1. Superficial and non-anatomical tenderness: Apply pressure with a single finger on various areas of the patient's back, such as the spinous processes, paraspinal muscles, and sacroiliac joints. Look for an exaggerated response or a response that is out of proportion to the amount of pressure applied.
2. Simulation of axial loading: Apply downward pressure on the top of the patient's head. Look for a non-organic response such as complaints of pain that do not correspond to the amount of pressure applied.
3. Distraction test: Ask the patient to perform a specific action, such as rotating their shoulders or extending their leg. While they are performing this action, apply pressure to the same area as in step 3a. Look for an exaggerated response or a response that is out of proportion to the amount of pressure applied.
4. Regional disturbances in sensation: Test the patient's response to light touch, pinprick, and temperature changes in various dermatomes (specific areas of skin innervated by a specific spinal nerve). Look for an inconsistent or non-anatomic pattern of response.
5. Widespread sensory changes: Test the patient's response to light touch, pinprick, and temperature changes in areas outside of the expected dermatomes. Look for an inconsistent or non-anatomic pattern of response.
6. Overreaction: Observe the patient's general behavior during the examination. Look for a disproportionate reaction to the testing, such as facial expressions of distress, verbal complaints of pain, or a tendency to exaggerate their symptoms.

The Waddell Test is not designed to diagnose specific conditions, but rather to identify potential non-organic or psychogenic factors that may be contributing to a patient's low back pain. As such, there are no specific "normal" results for this test.

References:

1. Abenhaim, L., Rossignol, M., Gobeille, D., & Bonvalot, Y. (2000). The prognostic consequences in the making of the initial medical diagnosis of work-related back injuries. Spine, 25(4), 518-524.
2. Fishbain, D. A., Cutler, R., Rosomoff, H. L., & Rosomoff, R. S. (1994). Validity of nonorganic signs in low back pain. Spine, 19(13), 1488-1493.