Flags of MSK system

Question 1

systems review flow

Answer 1

cardiovascular
nervous
GI
pulmonary
urogenital
endocrine
psychological

Question 2

what are red flags

Answer 2

cue to a more serious medical pathology
indicates if referral is necessary

Question 3

how are red flags in isolation interpreted

Answer 3

most people will check at least one or two red flag boxes but they are only informative when multiple are indicated

Question 4

how are red flags used

Answer 4

management strategy not a screen

Question 5

what do red flags give us more information about, diagnosis or prognosis?

Answer 5

prognosis

Question 6

what do unilateral red flags indicate

Answer 6

heighten us to be aware of changes over time

Question 7

what is medical screening

Answer 7

process in which disease/condition is assessed in an asymptomatic population who may or may not have disease precursors

Question 8

what does screening allow for? when is it typically done?

Answer 8

guide whether or not diagnostic testing should be done

preclinical phase

Question 9

when is diagnostic testing done

Answer 9

when symptoms are present

Question 10

relationship between red flags and prognosis

Answer 10

little to no red flags = good prognosis

many red flags = not as good

Question 11

identification in patients when using 10 or 23 items of the OSPRO

Answer 11

10 - 95%
23 - 100%

Question 12

what does OSPRO stand for

Answer 12

optimal screening for prediction of referral and outcome

Question 13

if there is a yes reported on the OSPRO, what needs to be done by a therapist

Answer 13

asking more questions
- why? when? how does it change?

Question 14

what does the OSPRO provide

Answer 14

prediction of 12 month quality of life and comorbidity change

Question 15

those with more “yes” answers on the OSPRO need to

Answer 15

monitored - watchful wait approach

Question 16

what is watchful waiting effective in

Answer 16

avoidance of unnecessary imaging/surgery

improving patient rapport

Question 17

mortality vs morbidity

Answer 17

mortality - death
morbidity - illness or disease

Question 18

how to manage red flags as a clinician

Answer 18

utilize screening test/tools versus imaging to identify a need first

Question 19

what are red flag conditions determined by

Answer 19

demographics
previous family history
previous medical/surgery history
medications
macro vs micro trauma
symptom descriptions
location of the body

Question 20

structures that produce pain

Answer 20

somatic
visceral
neural

Question 21

superficial structures that can cause somatic pain

Answer 21

skin
fascia
tendon sheaths

Question 22

deep structures that can cause somatic pain

Answer 22

periosteum of bone
muscles
tendons
joints
deep fascia
capsules
dura

Question 23

description of somatic pain

Answer 23

dull
aching
gnawing
diffuse
multiple dermatomes

Question 24

characteristics of somatic pain

Answer 24

improve with rest/non-weight bearing

increases with activity

no constitutional symptoms

more predictable pattern of response to position, rest or activity

Question 25

constitutional symptoms can be thought as

Answer 25

systemic symptoms

Question 26

visceral pain characteristics

Answer 26

not well localized
unpredictable pattern of response
does not change with rest or nonweight bearing

Question 27

what are the proposed visceral referred pain mechanisms

Answer 27

embryologic development
multi-segmental innervation
direct pressure and shared pathway

Question 28

what is embryologic development mechanism of referred visceral pain

Answer 28

neural networks formed between organs due to the position of the organs in development

will maintain through development when they separate

Question 29

what is the multisegmental innervation mechanism of visceral referred pain

Answer 29

overlapping innervations that will refer pain to corresponding somatic area due to sensory fibers entering spinal cord at the same level

Question 30

what is visceral organ cross-sensitization

Answer 30

multiple organs that have overlapping segmental projections have presentations of dysfunction

Question 31

what is the direct pressure and shared pathway mechanism of visceral pain referral

Answer 31

pain is referred through shared ganglions from each organ’s neural system where they gather and share information through the cord to the plexus

Question 32

descriptors of neuropathic pain

Answer 32

sharp, shooting, burning, lancinating

Question 33

how does brain tissue feel pain

Answer 33

it does not, it is insensitive to pain

Question 34

which types of pain need nociceptive information

Answer 34

somatic and visceral

Question 35

muscle pain description

Answer 35

cramping
dull
aching
poorly localized

Question 36

ligament or joint capsule pain description

Answer 36

dull
aching

Question 37

nerve root pain description

Answer 37

sharp
lancinating
shooting

Question 38

nerve pain description

Answer 38

sharp lancinating
lightening like

Question 39

bone pain description

Answer 39

deep
nagging
boring
dull
localized

Question 40

fracture pain description

Answer 40

sharp
severe
intolerable

Question 41

vascular pain description

Answer 41

throbbing
aching
diffuse
poorly localized

Question 42

nocioplastic pain description

Answer 42

disproportionate to activity or mechanism of injury
diffuse, non-anatomic areas

Question 43

method of action when a low level of concern is present

Answer 43

begin a trial of therapy
revision if clinical features change

Question 44

method of action when there are a few concerning features

Answer 44

begin a trial of therapy with a watchful waiting mentality

monitor progress or any changes in clinical presentations

Question 45

method of action when there are some concerning features

Answer 45

urgent referral
no therapy
further investigation (referral)

Question 46

method of action when there is a high level of concerning features

Answer 46

emergency referral
do not begin therapy

Question 47

types of yellow flags

Answer 47

pathological
precautions
psychological

Question 48

psychosocial yellow flags

Answer 48

fear avoidance
incorrect beliefs regarding exercise
pain catastrophizing
hypervigilance
depression
social withdrawal

Question 49

clinical presentation of fear-avoidance behaviors

Answer 49

reluctance to participate in activities that may increase symptoms

Question 50

clinical presentation of incorrect beliefs regarding exercise

Answer 50

belief that any exercise or movement that hurts a patient will cause more physical harm

Question 51

clinical presentation of pain catastrophizing

Answer 51

constant ruminating on one’s pain
magnification of the threat that the pain poses

Question 52

clinical presentation of hypervigilance

Answer 52

constantly on guard for threats to one’s safety

Question 53

yellow flag considerations

Answer 53

A - attitudes
B - beliefs
C - compensation
D - diagnosis
E - emotions
F - family
W - work

Question 54

something to consider when thinking about diagnosis yellow flags

Answer 54

inappropriate communication can lead to patient misunderstanding of their medical condition

Question 55

what measure and what score indicates a patient is at risk for chronic pain

Answer 55

orebro MSK pain questionnaire > 50
StarT Back = 4 or more

Question 56

examination for pain catastrophizing? what score is significant?

Answer 56

PCS
>30

Question 57

what is the examination for kinesiophobia? what score is significant?

Answer 57

TSK-11
11-44, higher is more avoidant

Question 58

what is the examination for avoidance behavior? what score is significant?

Answer 58

FABQ
>34 for work
>15 for physical activity