Lumbar Screening - Red Flags Flashcards
How common is serious disease when someone has a presents with pain in lumbar region?
- Not very common
Prescence of a single ____ is quite common
- red flag
- Use red flags in combination with clinical judgement
What are the 8 red flags of the lumbar spine?
- Cancer/Tumor
- Cauda Equina
- Infection
- Fracture
- AAA
- Kidney Disease
- Ankylosing Spondylitis
- Failure to Progress
Questions to screen for cancer
- Age over 50
- Personal Hx of Cancer
- Significant Unexplained weight loss (10% or more without trying)
- Do not get relief with laying down
- Failure of conservative treatment for 30 days
Questions to screen Cauda Equina
Any changes with bowel or bladder control?
Any numbness or tingling in the genital region? (Saddle Anethesia)
Questions to ask about infection
Are you otherwise generally healthy?
Any fevers?
Questions to screen Fractures
Over the age of 50
Hx of Steroid use
Hx of trauma
Osteoporosis
Questions to screen for AAA
- Cardiovascular Risk Factors (Smoking, Fam Hx, Male, Age over 50)
- Palpate or see an abdominal pulse
Questions to screen for kidney disease
Any blood in your urine?
Any issues with urinating?
Are you generally healthy?
- Often present with unilateral flank or LBP
- Difficulty with initiating urination, painful urination, or blood in uring
- Recent Hx of UTI
- Past episodes of kidney stones
- Positive percussion over the kidney
Signs of Ankylosing Spondylitis
- Insidious onet (late adolescence)
- Low back or SI
- Worse in the morning and worse with rest
- Don’t respond to Tx after 4 weeks
- More common in men
- Inflammatory Condition
What is considered a failure to progress in Tx?
- 30 days without improvement is grounds for medical investigation
When is imaging appropriate?
- Trauma, Osteoporosis, chronic steroid use, elderly individual (x-ray, CT, MRI)
- Suspicion of cancer, infection, cauda equina (MRI/CT)
- Progressive neuro symptoms or persistent Sx after 6 wks. PT (MRI/CT)
