Spine: Waddell signs: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: Waddell signs

Sample item

A man with chronic low back pain has pain on light axial loading of the skull, pain with simulated rotation of the pelvis and shoulders, and widespread non-anatomical tenderness. What do these findings suggest?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. A non-organic or psychological contribution to the pain

Waddell signs are five categories of non-organic findings: superficial or non-anatomical tenderness, simulation tests such as axial loading and rotation, distraction tests, regional disturbances and overreaction. Three or more positive categories suggest a non-organic component. They do not exclude organic disease and are not a test for malingering.

Option by option

  • A. Cauda equina syndrome

    Cauda equina syndrome presents with saddle anaesthesia and sphincter loss.

  • B. Ankylosing spondylitis

    Ankylosing spondylitis causes inflammatory back pain and reduced chest expansion.

  • C. Spinal tuberculosis

    Spinal tuberculosis causes constitutional symptoms and deformity.

  • D. A non-organic or psychological contribution to the pain (correct)

    Correct. These are Waddell signs of non-organic pain behaviour.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, A non-organic or psychological contribution to the pain. Waddell signs are five categories of non-organic findings: superficial or non-anatomical tenderness, simulation tests such as axial loading and rotation, distraction tests, regional disturbances and overreaction.

Why is "Cauda equina syndrome" not the answer?

Cauda equina syndrome presents with saddle anaesthesia and sphincter loss.

Why is "Ankylosing spondylitis" not the answer?

Ankylosing spondylitis causes inflammatory back pain and reduced chest expansion.

Why is "Spinal tuberculosis" not the answer?

Spinal tuberculosis causes constitutional symptoms and deformity.

What concept does this question test?

It tests Spine: Waddell signs in Orthopaedics. Three or more positive categories suggest a non-organic component. They do not exclude organic disease and are not a test for malingering.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: Waddell signs?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.