When the Signs Don’t Match the Story: Identifying Medical Inconsistencies

Waddell’s Signs are a group of physical signs, first described in a 1980 article in The Spine Journal, and named for the article’s principal author, Professor Gordon Waddell, a Scottish orthopedic surgeon. Waddell’s Signs may indicate non-organic or psychosocial components to chronic low-back pain. When three or more of the five signs listed below are present, a patient may be experiencing heightened emotional effects, and there is a high probability that he or she is experiencing non-organic pain or psychosocial issues:

1. Superficial and widespread tenderness or non-anatomic tenderness (skin discomfort due to a light touch or tenderness across non-anatomical boundaries). 
2. Stimulation tests: Axial loading and pain on simulated rotation (assessing pain when pressing down on top of the patient’s head or rotating the shoulders and pelvis together. Should not be painful). 
3. Distracted straight leg raise: If a patient complains of pain on straight leg raises, but not if the examiner extends the knee with the patient seated at another time during the initial evaluation. 
4. Non-anatomic sensory changes: regional sensory changes and weakness. Sensory loss in an entire extremity or side of the body or weakness that is non-consistent and jerky, e.g., “cogwheeling”. 
5. Overreaction: An exaggerated painful response to a stimulus that is not reproduced when the same stimulus is given later.

Although Waddell’s Signs is a popular test, many other tests that IME physicians use at their discretion can uncover medical inconsistencies. The list below shows a sampling of tests (not inclusive of all available tests). 

Common Tests Used by IME Physicians:  

• Mankopf’s Maneuver  
• Strength Reflex Test 
• Hip Adductor Test; Axial Loading Test
• Gordon’s Sign 
• Welberry Toe Test
• Hoover Test 
• Cervical Motion Test 
• Lumbar Motion Test 
• Grip Strength Test 
• Tuning Fork Test 
• Bowlus and Currier Test
• Magnuson’s Test

Next in line, “Separating Fact from Fiction: IMEs in the Detection of Malingering”. While IMEs aren’t designed to detect fraud, they can raise crucial red flags and reveal inconsistencies that reshape the trajectory of a claim. What happens when the pain doesn’t match the injury, or when the real issue lies beneath the surface? 

If you are ready to explore further, download the entire IME eBook here: Emperion eBook. 

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