Semiologia ortopedica pericial

Guides to the Impairment Rating of the Lumbar Spine
5th Edition
By Paul E. Wakim D.O., F.A.A.O.O.S.

Paul Wakim, D.O., F.A.A.O.O.S. Orthopedic SurgeonQME, AME, IME Emile P. Wakim, M.D.Orthopedic Surgeon,QME, AME, IME Robert Ahearn, M.D. Orthopedic Surgery &Disorders of the Spine, QME Kelsey Peterson, M.D. Orthopedic SurgeonM. Mike Kreidie, M.D. Neurologist, QME, AME, IME Jeffrey Bone, Psy.D. Psychologist-EEG/HEG Neurofeedback, QME Kevyn Dean, M.S.P.T.O.C.S.Physical Therapist

Definition of Terms:
• • • • • • Muscle Spasm/Muscle Guarding Asymmetric Range of Motion Nonverifiable Radicular Root Pain Reflexes/Sensory Loss/Atrophy EMG/NCV Alteration of Motion Segment Integrity

Muscle Spasm/Muscle Guarding
A. Muscle Spasm is a sudden involuntary contraction of a muscle or a group of muscles. To differentiate true muscle spasm from voluntary muscle contraction, the individual should not be able to relax the contractions. The spasm should be present standing as well as in the supine position and frequently causes a scoliosis. B. Muscle Guarding is a contraction of a muscle to minimize motion or agitation of the injured or diseased tissue. It is not true muscle spasm because the contraction can be relaxed. In the lumbar spine, the contraction frequently results in loss of the normal lumbar lordosis, and it may be associated with reproducible loss of spinal motion.

Asymmetric Range of Motion
Asymmetric motion of the spine in one of the three principal planes is sometimes caused by muscle spasm or guarding. If an individual attempts to flex the spine, he or she is unable to do so moving symmetrically; rather, the head or trunk leans to one side To qualify as true asymmetric motion, the finding must be reproducible and consistent and the examiner must be convinced that the individual is cooperative and giving full effort.

Nonverifiable Radicular Root Pain
Nonverifiable pain is pain that is in the distribution of a nerve root but has no identifiable