Red flag Questions

• Red flag Questions

  • Caution/contraindications
  • CNS involvement
  • Malignancy
  • Serious systemic illness
  • Active inflammatory joint disease
  • Drug history/abuse
• Special questions – spinal cord compression

  • Causes:
  • Disc protrusion
  • Tumour
  • Infection (pus collection)
  • Haematoma
  • Fractures
• Special questions – spinal cord compression

  • Questions:
  • Gait disturbance
  • Bilateral paraesthesia – (e.g. stocking +/or glove)
  • Bilateral limb weakness
• Cauda equina compression

  • Causes – includes disc extrusion, stenosis, tumour, etc
  • Potential surgical emergency
  • Very limited capacity for natural recovery
  • Symptoms - saddle anaesthesia, bladder/bowel dysfunction, bilateral sciatica

  
• Special Questions for lumbar spine

  • Cauda equina:
  • Bladder – particularly difficulty with micturition
  • Bowel – loss of anal sphincter tone
  • Saddle anaesthesia
  • Bilateral sciatica
  • Sexual dysfunction
• Special Questions for lumbar spine

  • Spinal cord:
  • Gait disturbance – unbalanced, ataxic type gait
  • Bilateral leg symptoms – especially paraesthesia in stocking distribution
  • Widespread or progressive motor weakness in legs
• Serious spinal pathology – e.g. # tumour, infection

  • Age > 50, < 20
  • History of cancer
  • Unexplained weight loss
  • Recent bacterial infection (e.g. UTI)
  • Immune suppression (medication or underlying condition)
  • Major trauma
  • Minor trauma in osteoporotic patient
  • Constant, progressive, non mechanical pain
  • Thoracic pain
  • Severe restriction lumbar flexion
  • Pain worse supine, severe night time pain
  • Structural deformity
  • Widespread neurology
• Pathology- Symptoms/situations that may cause concern

  • TB:
  • Past history
  • Family history/exposure
  • Travel to high risk areas
  • Night sweats, fever, cough
  • Persistent pain
  • Weight loss
• Pathology- Symptoms/situations that may cause concern

  • Cancer
  • Persistent pain at night
  • Constant pain
  • Unexplained weight loss (4.5-6.8kg in 2 weeks or less)
  • Loss of appetite
  • Unusual lumps or growths
  • Unwarranted fatigue
  • Past history
• Possible inflammatory disorders (spine)

  • Gradual onset before age 40
  • Marked EMS
  • Iritis, psoriasis, colitis
  • Urethral discharge
  • Peripheral joint involvement
  • Reduced spinal movements in all directions
  • Family history
  • Night pain – waking in latter half of night
  • WORSE WITH REST, BETTER WITH EXERCISE