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Orthopedic Tip of the Week

Orthopedic Tip of the Month

NON-ORGANIC NECK PAIN SIGNS

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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CONA Ortho Tip of the Month is designed for educational purposes only and is not engaged in rendering medical advice. The information provided through CONA Ortho Tip of the Month should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care.  If you have or suspect you may have a health problem, you should consult your health care provider. The authors, editors, producers, sponsors and contributors shall have no liability, obligation or responsibility to any person or entity for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a consequence of this material.