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Orthopedic Tip of the Week

Orthopedic Tip of the Month


Sobel and colleagues developed and assessed the reliability of a group of non-organic signs applicable to neck pain patients. 26 consecutive patients with neck pain histories of more than 4 months were evaluted by 2 health care providers for the presence of cervical non-organic signs. As patterned afte the low back pain signs of Waddell, the 5 signs consist of 7 tests as follows:

1. Tenderness

a. Superficial; patient reports pain with light touch or pinching.
b. Non-anatomical; widespread tenderness outside of the cervical/upper thoracic region to deep palpation.

2. Simulaton

a. Rotation of the head/shoulders/trunk/pelvis while standing.

3. Range of Motion

a. Patient rotates neck right and left as far as possible (positive if > 50% deficit in either direction)

4. Regional Disturbance

a. Sensory loss: light touch or pinprick decrease that is non-anatomical.

b. Motor loss: manual muscle testing with non-anatomical weakness with "giveway weakness" or observed normal strength but weakness when formal tests are performed.

5. Overreaction

At any time during the examination, any of the following are observed:

a. Moderate to extremely stiff, rigid, or slow movements
b. Rubbing the affected area for more than 3 seconds
c. Clutching, grasping, or squeezing the area for more than 3 seconds
d. Grimacing because of pain
e. Sighing
f. Disproprotionate verbalization
g. Muscle tension

The percent of agreement between the 2 raters ranged between 68% and 100% with simulation (seated test) being the lowest (68%) and regional sensory disturbance being the highest (100%). The average agreement was 84%. As the number of positive signs increased, so did the percentage of agreement. The test is considered positive if 3 of 5 signs are present.

Rehabilitation of the Spine, 2nd Edition, Craig Liebenson


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