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MSK 2 > 1a - Red and Yellow Flags > Flashcards

1a - Red and Yellow Flags Flashcards

1
Q

what are the 3 categories of med screening

A

appropriate for PT
yellow - appropriate w consult
red - not appropriate

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2
Q

what are clinical yellow flags (per this class definition)

A

pain associated psych distress that adversely influence outcomes for MSK pain

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3
Q

what type of factors are clinical red flags (per this class definition)

A

biomedical factors

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4
Q

what cases is the classification of neck pain into 4 groups especially helpful

A

if imaging isn’t showing a particular path
- can base treatment off of their clinical presentation instead

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5
Q

what are the steps per the CPGs when a pt comes in w neck pain

A
  1. med screening - appropriate for PT?
  2. classify neck pain into 4 groups
  3. determine condition stage (acute/subacute/chronic)
  4. intervention
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6
Q

what are the 4 groups that neck pain can be classified as

A
  1. neck pain w mobility deficits
  2. neck pain w HAs
  3. neck pain w movement coordination impairments (ie WAD)
  4. neck pain w radiating pain (ie radicular)
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6
Q

what are the 4 groups that neck pain can be classified as

A
  1. neck pain w mobility deficits
  2. neck pain w HAs
  3. neck pain w movement coordination impairments (ie WAD)
  4. neck pain w radiating pain (ie radicular)
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7
Q

how will acute neck pain present

A

highly irritable
- pain at rest or w initial to mid-range spinal movements (ie before tissue resistance)

time component to pain
- pain won’t stop after stopping activity
- will take good amt of time to recover

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8
Q

how will subacute neck pain present

A

mod irritability
- pain w mid-range motions that worsens w end-range spinal movements (ie w tissue resistance)

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9
Q

how will chronic neck pain present

A

low degree of irritability
- pain worsens w sustained end-range spinal movements or positions (ie overpressure into tissue resistance)

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10
Q

urgent vs emergent referral

A

urgent - not emergency/911, but needs follow up
- ex: neck pain w gait disturbance/LOB

emergent - 911
- ex: chest pain w exertion, cardiac issue, stroke - concern for cervical/arterial dissection, VBI

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11
Q

what is the OSPRO-ROS

A

Optimal Screening for Prediction of Referral and Outcome - Review of Systems
- identify red flags w high accuracy

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12
Q

what are 8 cervical red flags

A
  1. neoplastic conditions
  2. cervical fx
  3. upper cervical ligamentous injury/instability
  4. systemic inflammatory disease
  5. infection
  6. cardiac
  7. cervical vascular path
  8. cervical myelopathy*
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13
Q

pt comes in complaining of severe neck pain or HA unlike any other, what is likely the path

A

arterial

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14
Q

pt comes in not feeling well, fever, chills - what is likely the path

A

infection

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15
Q

pt has pain on exertion, what is likely the path? what should you do?

A

cardiac
check VS

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16
Q

pt isn’t improving in PT for over a month now, what do you do

A

reason for a referral
- could be a medical issue that needs to be treated

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17
Q

what are 2 systemic inflammatory diseases and why are these red flags in the neck

A

ankylosing spondylosis, RA

could make condition worse, more sensitive
** more ligamentous laxity in upper cervical spine - esp transverse lig***
- more cautious in upper c-spine, esp AA region

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18
Q

what is myelopathy

A

dz/neurologic deficit related to spinal cord

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19
Q

what is degenerative cervical myelopathy

A

aka compressive cervical myelopathy; cervical spondylitic myelopathy

  • compression of SC caused by narrowing of spinal canal from degenerative changes, disc herniation, or osteophyte formation
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20
Q

what is radiculopathy

A

any dz of spinal nerve roots and spinal nerves
- pain and/or neuro deficit in a specific nerve root distribution resulting in motor loss, sensory changes, and sometimes depression of reflexes

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21
Q

what are 3 etiologies of cervical myelopathy

A

acquired
traumatic
spinal cord tumor

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22
Q

how are cervical myelopathy typically acquired

A

cervical spinal stenosis -degenerative dz superimposed on congenitally narrow canal

23
Q

what are 6 traumatic etiologies of cervical myelopathy

A

spinal shock
hematomyelia
spinal epidural hematoma
barotrauma
electrical injuries
compression by bone fx
- could be minor trauma after setting of spinal stenosis

24
Q

where are spinal canal tumors responsible for cervical myelopathy typically located

A

usually extradural (55%), followed by 40% intradural extramedullary (ie meningiomas, neurofibromas)

intramedullary spinal cord tumors are relatively uncommon (5%)

25
Q

how is degenerative cervical myelopathy dx

A

thru neurological exam
MRI

26
Q

what are the Nurick Classification grades for degenerative cervical myelopathy

A

grade 1: mild
- UMN signs w normal gait
- can be treated conservatively
- yellow flag - close monitoring

grade 2-5: mod to severe
- UMN signs, worsening gait disturbances
- poor prog
- generally treated surgically (surgical decompression)

27
Q

how does pure myelopathy present in degenerative cervical myelopathy? how common is this?

A

UMN signs below level of the lesion
50% of the time

28
Q

how does a combination of myelopathy and radiculopathy present in degenerative cervical myelopathy? how common is this?

A

LMN signs at level of lesion, UMN signs below level of lesion

49% of the time

29
Q

what is a risk factor for developing myelopathy after a disc herniation

A

congenitally narrow spinal canal

30
Q

what might be the first presentation of degenerative cervical myelopathy

A

sensory disturbance in hand
- could be presenting as carpal tunnel

31
Q

if a sensory disturbance in hand is present for awhile in degenerative cervical myelopathy, how can this progress

A

result in loss of dexterity of hands
- ie opening soda, doing buttons on shirt

32
Q

what is a more severe presentation of degenerative cervical myelopathy

A

sphincter disturbance

33
Q

what are the 5 most common s/sx associated w degenerative cervical myelopathy

A
  1. hyper-reflexia
  2. babinski reflex
  3. spasticity
  4. sphincter disturbance
  5. sensory disturbance in hands beginning in finger tips, progressing proximally
34
Q

what are the s/sx of degenerative cervical myelopathy (14- but think of main groups/clusters)

A
  1. neck pain, radicular arm pain
  2. HAs, dizziness
  3. wide based or unsteady gait
  4. hyper-reflexia, spasticity, clonus
  5. presence of pathologic reflexes: babinski, hoffmans, rhomberg
  6. sensory disturbance in hands distal -> prox, intrinsic ms wasting of hands, loss of dexterity of hands
  7. non specific weakness of extremities
  8. sphincter disturbance
35
Q

how do sx of degenerative cervical myelopathy present

A

often unilateral or absent in UE
bilateral in LE

36
Q

how does degenerative cervical myelopathy present over time

A

progressive hx w stable neurological function b/w exacerbations

37
Q

what are the 5 clustered findings for dx of cervical spinal myelopathy (CSM)

A
  1. age >45yo
  2. (+) hoffman’s sign
  3. (+) inverted supinator sign
  4. (+) babinski test
  5. (+) gait abnormality
38
Q

treatment guidelines for degenerative cervical myelopathy (DCM)

A

MILD: surgery or supervised structured rehab
MOD/SEVERE: surgery

nonop: watch for neuro deterioration
- surgery recommended if neuro deterioration or pt fails to improve

39
Q

what are 4 rehab strategies for DCM

A

manual therapy
exercise - cervical stabilization
balance training
core stability

40
Q

what manual therapy is utilized in DCM

A

thoracic mobs/manip
cervical traction

41
Q

what are 3 self-report questionnaires utilized w yellow flag screening

A
  1. Fear-Avoidance Belief Questionnaire (FABQ)
  2. Pain Catastrophizing Scale
  3. OSPRO-YF
42
Q

what subscales make up the FABQ

A
  1. physical activity (FABQPA)
  2. work (FABQW)
43
Q

what pt is the FABQ appropriate to utilize in

A

people who are afraid of moving, scared it will make the pain worse

44
Q

how are the results of the FABQ interpretted

A

higher score = higher level of fear avoidance

45
Q

what is the cut-off score for the FABQ? why is there a cut-off scores? what other outcome tool can validate that cut off

A

cut-off score = 48

presence of prolonged disability in pts w neck pain is partially related to fear-avoidance beliefs

NDI is best predictor of those at risk for prolonged neck disability

46
Q

what are 3 signs that a pt is catastrophizing their pain

A
  1. ruminate about pain
  2. magnify their pain
  3. feel helpless to manage their pain
47
Q

what is a clinically significant score Pain Catastrophizing Scale and what does this mean

A

30
represents clinically relevant level of catastrophizing

48
Q

how are the results from the Pain Catastrophizing Scale interpreted

A

high score = worse

49
Q

what is the OSPRO-YF

A

concise yellow flag assessment tool that allows for accurate estimates of 11 individual psych questionnaire scores

50
Q

what are the 3 main categories of pt psych status does the OSPRO-YF assess

A
  1. neg mood
  2. fear avoidance
  3. pos affect/coping
51
Q

what pt is the OSPRO-YF especially helpful in

A

if not sure what the problem is

52
Q

how are the results of the OSPRO-YF interpreted

A

higher score = higher level of yellow flag

53
Q

what are the main strategies of PIPT (2)

A

pt ed
- movement is important
- pain might be okay

do better in group setting
- w other pts, in gym
- better for motivation

54
Q

what pts are appropriate for PIPT vs PIPT w referral

A

PIPT
- mod impact of yellow flags
- no sx of mental illness

PIPT w referral
- mod-high impact of YFs
- sx of mental illness

MSK 2 (20 decks)

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