Guidelines for the assessment of permanent impairment Version 3

Definitions of clinical findings used to place a worker in a DRE categoryDefinitions of clinical findings which are used to place a worker in a DRE category are provided in the boxbelow.Definitions of clinical findingsMuscle spasmMuscle spasm is a sudden, involuntary contraction of a muscle or a group of muscles. Paravertebral musclespasm is common after acute spinal injury but is rare in chronic back pain. It is occasionally visible as acontracted paraspinal muscle but is more often diagnosed by palpation (a hard muscle). To differentiate truemuscle spasm from voluntary muscle contraction, the worker should not be able to relax the contractions. Thespasm should be present standing as well as in the supine position and frequently causes scoliosis. The medicalassessor can sometimes differentiate spasm from voluntary contraction by asking the worker to place all his orher weight first on one foot and then the other while the medical assessor gently palpates the paraspinal muscles.With this manoeuvre, the worker normally relaxes the paraspinal muscles on the weight-bearing side. If themedical assessor witnesses this relaxation, it usually means that true muscle spasm is not present.Muscle guardingGuarding is a contraction of muscle to minimise motion or agitation of the injured or diseased tissue. It is not truemuscle spasm because the contraction can be relaxed. In the lumbar spine, the contraction frequently results inloss of the normal lumbar lordosis, and it may be associated with reproducible loss of spinal motion.Non-uniform loss of spinal motion (dysmetria)Non-uniform loss of motion of the spine in one of the three principle planes is sometimes caused by muscle spasmor guarding. To qualify as true non-uniform loss of motion, the finding must be reproducible and consistent andthe medical assessor must be convinced that the worker is co-operative and giving full effort.Non-verifiable radicular complaintsNon-verifiable radicular complaints are symptoms (e.g. shooting pain, burning sensation, tingling) that follow thedistribution of a specific nerve root, but there are no objective clinical findings (signs) of dysfunction of the nerveroot (e.g. loss or diminished sensation, loss or diminished power, loss or diminished reflexes.ReflexesReflexes may be normal, increased, reduced or absent. For reflex abnormalities to be considered valid, theinvolved and normal limbs should show marked asymmetry on repeated testing. Abnormal reflexes such asBabinski signs or clonus may be signs of corticospinal tract involvement.Weakness and loss of sensationTo be valid, the sensory findings must be in a strict anatomic distribution, i.e. follow dermatomal patterns. Motorfindings should also be consistent with the affected nerve structure(s). Significant long-standing weakness isusually accompanied by atrophy.WCT Guidelines 1 October 2011 25