Medical Signs
You order medical records, you talk with doctors, they tell you stuff, but ever wonder what it means? Recently I had to look up some “signs” to understand exactly what the doctor meant. This might make a good reference as you read the medical reports:
* cogwheel phenomenon: jerky motions produced on testing a
muscle’s strength, the jerks are neither rhythmic nor equal and
represent malingering or protection from pain
* SLR: straight leg raising or Lasegue, for determining nerve root
irritation, while lying down, the patient elevates his leg straight until there is back pain, or until
the pain is increased with flexion of the foot
* valsalva maneuver: for determining nerve root irritability within the spinal canal, patient takes a deep breath and then on bearing down (such as a lifting task) notes if pain occurs or is
increased
* long tact sign: any sign that one would see in affection of either sensory or motor tracts in the spinal cord
* romberg test: for differentiation between peripheral and cerebellar ataxia (useful in
determining central brain cause)
For more terms like this see www.orthoteer.co.uk/Nrujp . Now on to malingering tests: You are talking with the doctor, and he says “well, he does have positive Waddel’s signs” so I can’t really support a back injury”. You nod in agreement, but inside are wondering “what is he saying?” So here goes:
Non-organic causes of pain include malingering (for secondary gain), Munchausen’s syndrome (intentional production of clinical signs, the treatment becomes the secondary gain), and psychosomatic disorders which are manifestations of psychological (the mind) with somatic (the body) complaints. The back is a common site of nonorganic musculoskeletal complaints. In 1980 Dr. Waddell identified 8 behavioral signs that are consistently reliable and reproducible for identifying nonstructural problems in patients with low back pain. The 8 signs are:
* superficial tenderness: skin discomfort on palpation
* nonanatomic tenderness: tenderness that crosses multiple somatic boundaries
* axial loading: report of low back pain after pushing down on head
* simulated rotation: report of low back pain after turning body from side to side
* SLR: report of pain in back or thigh with minimal leg raising
* regional sensory change: stocking or global distribution of numbness
* regional weakness: sudden, uneven weakness such as cogwheeling
* overreaction: exaggerated, nonreproducible response to stimulus
Most physicians agree that 3-4 out of these 8 should be present before making the determination that there is a nonorganic cause of pain. By the way, any time you see that phrase, “nonorganic cause of pain”, figure that you need a conference with the physician to understand the situation.
More on this, see www.postgradmed.com/issues/1999/12_99/kiester.htm
