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<embedvideo service="youtube" Alignment="right">https://youtu.be/WOhfYdcj8Jk</embedvideo>Waddell (touch-me-not) signs are a set of tests for nonorganicity in low back pain (Video).(1-3) The Waddell signs include a discrepancy between the positivity of straight leg raising between the supine and seated position; pain in the back on pressing down on top of the head; widespread and excessive tenderness (the “touch-me-not” sign); general overreaction during testing; pain during simulated spinal rotation, pinning the patients hands to the sides while rotating the hips (no spine rotation occurs as shoulders and hips remain in a constant relationship); and nondermatomal/nonmyotomal neurologic signs.
When hemiballismus results from a lesion of the contralateral STN, the damage to the STN removes its normal facilitation of the inhibitory effects of GPi/SNr. Without STN input, GPi/SNr inhibition of the motor thalamus decreases, causing increased thalamocortical activity and hyperkinesis.
Video legend. Hemiballismus. The movements were unremitting and medically intractable but resolved after pallidotomy, see Suarez et al (5)
Video courtesy of Stephen G. Reich, Department of Neurology, University of Maryland.
1. Hawley, JS and Weiner, WJ. Hemiballismus: current concepts and review. Parkinsonism Relat Disord. 2012; 18:125-129.
2. Rocha Cabrero F, De Jesus O. Hemiballismus. 2021 Aug 30. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
3. Kataja Knight A, Magnusson P, Sjöholm Å. Hemiballismus in hyperglycemia. ClinCase Rep. 2021;9:e04343.
4. Ticona J, Zaccone V, Zaman U, et al. Hemichorea-Hemiballismus as an Unusual Presentation of Hyperosmolar Hyperglycemic Syndrome. Am J Med Case Rep. 2020;8:159-161.
5. Suarez JI, Metman LV, Reich SG, Dougherty PM, et al. Pallidotomy for hemiballismus: efficacy and characteristics of neuronal activity. Ann Neurol 1997;42:807-11).
[[Category: Motor Signs]]
