Flags and Diagnosis Flashcards
What does VINDICATE stand for?
V - Vascular/Visceral
I - Infection/Inflammatory
N - Neoplasm/Neurological
D - Degenerative
I - Idiopathic/Iatrogenic
C - Congenital
A - Autoimmune
T - Trauma
E - Endocrine
Vascular/Visceral - neck pain differential diagnosis
Carotid/vertebral artery dissection; stroke
Infection/Inflammatory - neck pain differential diagnosis
Osteomyelitis, RA
Neoplasm/ Neurological - neck pain differential diagnosis
Primary, metastatic, Spinal stenosis, disc prolapse
Degenerative - neck pain differential diagnosis
DJD, spinal stenosis, disc prolapse
Congenital - neck pain differential diagnosis
transerve & alar ligament abnormalities
Trauma - neck pain differential diagnosis
fractures, sprain, muscle strain
Endocrine - neck pain differential diagnosis
Corticosteroids, osteoporosis
What are Red flags?
signs and symptoms that raise suspicion of serious pathology
Cauda equina syndrome - red flags
Signs:
- sensory deficit in saddle to light touch and pinprick
- abnormal lower limb neurology
Symptoms:
- sensory change (LL)
- Motor weakness (LL)
- saddle sensory disturbance
- change in ability to achieve an erection or ejaculate
- loss of sensation in genitals
- change in bowel function and or habits
- unilateral/bilateral leg pain
- low back pain
Fracture - Red Flags
Signs:
- bone tenderness
- neurological signs
- spinal or limb deformity
- Contusion or abrasion
Symptoms:
- Thoracic pain
- severe pain
- neurological symptoms
Malignancy - Red Flags
Signs:
- Altered sensation from trunk down
- neurological signs
- bony tenderness
Symptoms:
- Severe pain that may become progressive and constant
- Unremitting night or non mechanical pain
- Systemically unwell
- Thoracic pain
- neurological pain
- unexplained weight loss
- unfamiliar back pain
Infection - Red Flags
Signs:
- neurological signs
- radiculopathy
- bony tenderness
Symptoms:
- Spinal pain
- Neurological symptoms
- Fatigue
- Fever
- Unexplained weight loss
Cervical Region Dissection - Red Flags
Signs:
- Unsteadiness
- Dysphasia
- Weakness
- Nausea/vomiting
- Facial palsy
- Ptosis
- Loss of consciousness
- Confusion
- Dizziness/Disequilibrium
Symptoms:
- Drowsiness
- HA
- Neck pain
- Visual disturbance
- Paresthesia
- Dizziness
Cervical Region Non-Dissection - Red Flags
Signs:
- Unsteadiness/ataxia
- Dysphasia
- Weakness
- Nausea/vomiting
- Facial palsy
- Ptosis
- Loss of consciousness
- Confusion
- Drowsiness
Symptoms:
- HA
- Paresthesia
- Viscual disturbance
- Neck pain
- Dizziness
Cervical Ligamentous Instability - Red Flags
- Overt loss of balance in relation to head movements
- Facial lip paresthesia, reproduced by active or passive neck movements
- Bilateral or quadrilateral limb paresthesia either constant or reproduced by neck movements
- Nystagmus produced by AROM or PROM
- Production or aggravation of symptoms due to movement of head/neck
Secondary HA disorders - Red Flags
- Systemic symptoms including fever
- Neoplasm in history
- Onset of HA is sudden or abrupt
- Older age (50+)
- Pattern change or recent onset of HA
- Positional HA
- Precipitated by sneezing, coughing or exercise
- Papilledema
- Progressive HA or atypical presentation
- Pregnancy or puerperium
- painful eye with autonomic features
- Posttraumatic onset of HA
- Pathology of immune system such as HIV
- Painkiller overuse or new drug at onset of HA
Abdominal Aortic Aneurysm - Red Flag
Signs:
- Often, no noticeable signs early stages
- advanced stage abdominal pain, pulsating abdominal mass
- Rupture: sudden onset of intense abdominal pain, drop in BP, SSX of Shock
Symptoms:
- Often no noticeable symptoms in early stages
- persistent back pain
- rupture: sudden onset of intense abdominal pain, drop in BP, SSX of Shock
Acute Cardiac event - Red Flags
Signs:
- sweating, pallor
- bradycardia, tachycardia
Symptoms:
- SOB
- Fatigue
- Chest pain
- Pain radiating to shoulder, arm or jaw
- upper abdominal discomfort
- nausea
- vomiting
- dizziness
- Palpitations
Pain Types
Nociceptive pain (most common, potentially harmful stimuli, usually acute
Neuropathic pain (injured neural structures, acute or chronic, increased risk of chronicity)
Nociplastic pain
Yellow flags
barrier to recovery
anxiety
depression
fear avoidance
catastrophizing
Red Flags for Neck pain, signs of Instability, CAD
- new neck pain in older population
- new onset with history of cancer
- pain with fever, neck stiffness and meningeal signs
- night pain
- progressively worsening
- neurological signs (nystagmus, vertigo, loss of balance, visual disturbances, difficulty speaking or swallowing)
- significant trauma
