Symptom Magnification and Malingering in Orthopedic Cases
By: Steven Babitsky, Esq.
Many employers, insurers, and self-insurers suspect workers’ compensation claimants of symptom magnification or malingering.
These terms have been defined as follows:
A conscious or unconscious self-destructive, socially-reinforced, behavioral response pattern consisting of reports or displays of symptoms which function to control the life circumstances of the sufferer.
A conscious and willful fainting or exaggeration of a disease or effect of an injury in order to obtain specific external gain. It is usually motivated by external incentives, such as receiving financial compensation, obtaining drugs, or avoiding work or other responsibilities.
The physicians performing Independent Medical Evaluations in orthopedic cases need to correlate the examinees’ subjective complaints with his/her objective findings.
A common method of testing for exaggeration of faking is the use of Waddell’s signs.
These signs include:
- Positive Waddell’s sign for tenderness- if there is deep tenderness over a wide area, that is a positive sign.
- Stimulation – downward pressure on the head causes low back pain is a positive sign. The examiner holding the shoulders and hips in the same plane and rotating patient, resulting in pain is a positive sign.
- Distraction – straight leg raise causes pain when formally tested, but straightening the leg with the hip flex 90 degrees to check Babinski sign does not cause pain, is a positive sign.
- Regional – if there is weakness in multiple muscles not enervated by the same root sensation, such as a “glove and stocking” loss of sensation, this is a positive sign.
- Overreaction – if there is an excessive show of emotion, this is a positive sign.
- Test to detect false paresis (weakness or loss of voluntary movement) is the “arm drop” test. The examiner holds the paretic hand above the patient’s face and drops it, if that hand misses the patient’s face on the way down, the paresis is non-organic.
Dr. Ronald Zipper will be performing a demonstration of a Live Orthopedic IME Exam at the SEAK 33rd Annual National Workers’ Compensation and Occupational Medicine Conference to be held on July 16-18, 2013 on Cape Cod, MA.
He will demonstrate for attendees the Waddell tests as well as other distraction tests including:
- Mankopf’s Maneuver
- Strength Reflex Test
- Hip Adductor Test; Axial Loading Test
- Welberry Toe Test
- Hoover Test
- Cervical Motion Test
- Lumbar Motion Test
- Grip Strength Test
- Tuning Fork Test
- Bowlus and Currier Test
- Magnuson’s Test
For additional information about the SEAK National Workers’ Compensation and Occupational Medicine Conference click here.
Steven Babitsky is the conference leader.
Ronald Zipper, DO, FAOAO, FAADEP, CEDIR is an orthopedic surgeon in Kansas City, Missouri. He is a certified independent medical examiner (CIME) and has extensive IME and medical-legal experience. As a nationally and internationally lecturer, Dr. Zipper has lectured on topics including: Orthopedics; Sports Medicine; Occupational Medicine; Impairment; Disability; and Expert Witness Deposition and Testifying Skills. His independent medical examinations and peer reviews have included cases from 37 states. He was team physician for the semi-professional Missouri Bulldogs Football team. His practice has included multiple NFL and Indoor Soccer league athletes. Dr. Zipper received his B.S. in Biology from Temple University-Philadelphia, PA., 1971. He received his Doctor of Osteopathy (D.O.), 1976, and completed his residency in Orthopedic Surgery in 1981 from the University of Health Sciences College of Osteopathic Medicine (UHS-COM), Kansas City, MO. His Fellowships were in Hand Surgery at Thomas Jefferson Medical School, Philadelphia, PA., and in Arthroscopic Surgery, at Grand Rapids Osteopathic Hospital, Grand Rapids, MI., in 1981. Dr. Zipper was the first osteopathic physician elected as president and subsequently chairman of the board of the American Academy of Disability Evaluating Physicians.