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Abstract
Experienced medical examiners perform detailed physical examinations that document negative, positive, and nonorganic findings. The latter are observations or subjective reports that cannot be readily explained on an anatomical basis. Nonorganic findings have been described since the early part of the 20th century, and nonorganic physical signs in low back pain were defined in 1979. Cervical nonorganic signs also have been developed, standardized, and proven reliable. Nonorganic symptoms and signs may indicate symptom magnification behavior or malingering, particularly if multiple findings are noted and are closely correlated with psychological distress and abnormal illness behavior. The presence of these findings does not necessarily preclude organic pathology. Table 1 extensively lists some of the tests commonly used by independent medical examiners to determine whether findings are nonorganic. Columns in the table list the area for which the test is used (eg, back pain, muscle spasm, or muscle weakness), the name of the test or maneuver (eg, log rolling, pinch test, or others), and a description with notes and recommendations.
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1
Babitsky S, Brigham CR, Mangraviti J. Symptom Magnification, Deception and Malingering: Identification Through Distraction and Other Tests and Techniques [video presentation] Falmouth, Mass: SEAK—Medical and Legal Information Systems; 2000.
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2
Collie J. Malingering and Feigned Sickness. London: Edward Arnold Ltd; 1913.
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Hoover CF. A new sign for the detection of malingering and functional paresis of the lower extremities. JAMA. 1908;51:746-747.
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Waddell G, McCulloch JA, Kummel E, Venner R. Nonorganic physical signs in low-back pain. Spine. 1980;5:117-125.
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Sobel JB, Sollenberger PT, Robinson R, Polatin PB., Gatchel RJ Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study. Arch Phys Med Rehabil. 2000;81:170-175.
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6
Doxey NC, Dzioba RB, Mitson GL, Lacroix JM. Predictors of outcome in back surgery candidates. J Clin Psychol. 1988; 44:611-621
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