Flags of MSK system Flashcards
systems review flow
cardiovascular
nervous
GI
pulmonary
urogenital
endocrine
psychological
what are red flags
cue to a more serious medical pathology
indicates if referral is necessary
how are red flags in isolation interpreted
most people will check at least one or two red flag boxes but they are only informative when multiple are indicated
how are red flags used
management strategy not a screen
what do red flags give us more information about, diagnosis or prognosis?
prognosis
what do unilateral red flags indicate
heighten us to be aware of changes over time
what is medical screening
process in which disease/condition is assessed in an asymptomatic population who may or may not have disease precursors
what does screening allow for? when is it typically done?
guide whether or not diagnostic testing should be done
preclinical phase
when is diagnostic testing done
when symptoms are present
relationship between red flags and prognosis
little to no red flags = good prognosis
many red flags = not as good
identification in patients when using 10 or 23 items of the OSPRO
10 - 95%
23 - 100%
what does OSPRO stand for
optimal screening for prediction of referral and outcome
if there is a yes reported on the OSPRO, what needs to be done by a therapist
asking more questions
- why? when? how does it change?
what does the OSPRO provide
prediction of 12 month quality of life and comorbidity change
those with more “yes” answers on the OSPRO need to
monitored - watchful wait approach
what is watchful waiting effective in
avoidance of unnecessary imaging/surgery
improving patient rapport
mortality vs morbidity
mortality - death
morbidity - illness or disease
how to manage red flags as a clinician
utilize screening test/tools versus imaging to identify a need first
what are red flag conditions determined by
demographics
previous family history
previous medical/surgery history
medications
macro vs micro trauma
symptom descriptions
location of the body
structures that produce pain
somatic
visceral
neural
superficial structures that can cause somatic pain
skin
fascia
tendon sheaths
deep structures that can cause somatic pain
periosteum of bone
muscles
tendons
joints
deep fascia
capsules
dura
description of somatic pain
dull
aching
gnawing
diffuse
multiple dermatomes
characteristics of somatic pain
improve with rest/non-weight bearing
increases with activity
no constitutional symptoms
more predictable pattern of response to position, rest or activity
constitutional symptoms can be thought as
systemic symptoms
visceral pain characteristics
not well localized
unpredictable pattern of response
does not change with rest or nonweight bearing
what are the proposed visceral referred pain mechanisms
embryologic development
multi-segmental innervation
direct pressure and shared pathway
what is embryologic development mechanism of referred visceral pain
neural networks formed between organs due to the position of the organs in development
will maintain through development when they separate
what is the multisegmental innervation mechanism of visceral referred pain
overlapping innervations that will refer pain to corresponding somatic area due to sensory fibers entering spinal cord at the same level
what is visceral organ cross-sensitization
multiple organs that have overlapping segmental projections have presentations of dysfunction
what is the direct pressure and shared pathway mechanism of visceral pain referral
pain is referred through shared ganglions from each organ’s neural system where they gather and share information through the cord to the plexus
descriptors of neuropathic pain
sharp, shooting, burning, lancinating
how does brain tissue feel pain
it does not, it is insensitive to pain
which types of pain need nociceptive information
somatic and visceral
muscle pain description
cramping
dull
aching
poorly localized
ligament or joint capsule pain description
dull
aching
nerve root pain description
sharp
lancinating
shooting
nerve pain description
sharp lancinating
lightening like
bone pain description
deep
nagging
boring
dull
localized
fracture pain description
sharp
severe
intolerable
vascular pain description
throbbing
aching
diffuse
poorly localized
nocioplastic pain description
disproportionate to activity or mechanism of injury
diffuse, non-anatomic areas
method of action when a low level of concern is present
begin a trial of therapy
revision if clinical features change
method of action when there are a few concerning features
begin a trial of therapy with a watchful waiting mentality
monitor progress or any changes in clinical presentations
method of action when there are some concerning features
urgent referral
no therapy
further investigation (referral)
method of action when there is a high level of concerning features
emergency referral
do not begin therapy
types of yellow flags
pathological
precautions
psychological
psychosocial yellow flags
fear avoidance
incorrect beliefs regarding exercise
pain catastrophizing
hypervigilance
depression
social withdrawal
clinical presentation of fear-avoidance behaviors
reluctance to participate in activities that may increase symptoms
clinical presentation of incorrect beliefs regarding exercise
belief that any exercise or movement that hurts a patient will cause more physical harm
clinical presentation of pain catastrophizing
constant ruminating on one’s pain
magnification of the threat that the pain poses
clinical presentation of hypervigilance
constantly on guard for threats to one’s safety
yellow flag considerations
A - attitudes
B - beliefs
C - compensation
D - diagnosis
E - emotions
F - family
W - work
something to consider when thinking about diagnosis yellow flags
inappropriate communication can lead to patient misunderstanding of their medical condition
what measure and what score indicates a patient is at risk for chronic pain
orebro MSK pain questionnaire > 50
StarT Back = 4 or more
examination for pain catastrophizing? what score is significant?
PCS
>30
what is the examination for kinesiophobia? what score is significant?
TSK-11
11-44, higher is more avoidant
what is the examination for avoidance behavior? what score is significant?
FABQ
>34 for work
>15 for physical activity
