medical screening Flashcards
Mechanical Pain
Patient will report an incident, traumatic event, or an event that precipitates the onset of symptoms
Symptoms can be aggravated or relieved with changes in body or limb position or as a response to specific movements
Symptoms can be reproduced or provoked with:
Palpation
Active or passive movement
Resistive Tests
Special Tests
Non-Mechanical Pain onset
Difficult to connect the onset of pain with a specific incident or event
Visceral pain characterized as
non- mechanical pain
Dull, diffuse, poorly localized
May rhythmically build and recede
May be described as “constant”
- no change with position or posture
Non-Mechanical Pain reproduced
Chemical or mechanical stimulus
Mechanical – movement
Chemical – temp change, eating, this chemical stimulus can be refereed to a specific place
Typically, within the organ’s own environment
Follow a predictable referral pattern
Broad Clinical Concerns
Fever, chills, sweats
Unexplained weight loss
Fatigue / Malise
Unexplained nausea and vomiting
Sometimes unremitting
Night Pain
Inability to increase or decrease pain / symptoms
what kind of population do we often see pathological fractures
Older individual
Female – older
Prolonged corticosteroid use
Decrease estrogen
Decrease bone and tendon generation
History of osteoporosis
Sacral Stress Fracture see with
Athletic female
Increased level of vigorous/repetitive athletic activity
Dietary insufficiency
Previous stress fractures
Nonresponsiveness to previous treatment
To get better have to shut them down
Sacral Stress Fracture pain
Pain involves the buttock
Pain reproduced with athletic activities (e.g., running
Menstrual irregularities
what is the Sign of the Buttock
It is a combination of findings that indicates serious pathology of the gluteal or low back region.
parts of the Sign of the Buttock
Limited trunk flexion noted during standing examination
Supine Straight Leg Raise (SLR) limited and painful
Hip flexion with knee flexion limited, painful and limitation is GREATER than that of the SLR
Hip rotation is painful and limited but in a non-capsular pattern
Empty end feel on hip flexion
Spondylolisthesis / Spondylolysis
Fracture of the PARS Interarticularis
Spondylolisthesis / Spondylolysis normal seen in what pop
Young individual
Spondylolisthesis / Spondylolysis normally due to
Repetitive hyperextension injury
Seen commonly in wrestlers and American football linemen
Spondylolisthesis / Spondylolysis pain
Sudden severe bilateral sciatica occurred during athletic activity
Pain with extension (prone with passive bilateral hip extension)
No urinary bowel incontinence
Abdominal Aortic Aneurysm (AAA) symptoms
Pain at rest or at night
Pulsating abdominal mass that is found with inspection or palpation of the abdomen
Patient typically complains of a throbbing type pain
Symptoms cannot be provoked with mechanical examination of the lower back
Referred pain to the lower back
risk for AAA
Family history of cardiovascular disease
Risk increases with family hx AAA
Claudication
pain in the legs or arms that occurs while walking or using the arms
caused by too little blood flow to the legs or arms.
Stenosis
narrowing
Vascular Claudication seen in what pop
Older individual
Family history of cardiovascular disease
Vascular Claudication pain and symptoms
Pain in the calf with activity relieved with rest
One foot is colder than the other
Symptoms cannot be provoked with mechanical examination of the lower back
Positive inclined treadmill test
Shopping cart – must lean forward and they fell better
Kidney Stones pain
Sudden sharp pain of intermittent nature; it reaches the testicles or labium
Low back pain that will radiate towards the front
Same pain with fever
renal infection
Symptoms cannot be provoked with mechanical examination of the lower back
Other Genitourinary Issues
UTI, STD
Lumbosacral pain, associated with abdominal pain
Pain occurs after eating in upper lumbar area (L1–2)
Pain can be relieved by further intake of food
Night pain
Typically symptoms are chronic and progressive
Symptoms cannot be provoked with mechanical examination of the lower back
Not reproduceable
Ankylosing Spondylitis what pop
Middle-aged individual
What is Ankylosing Spondylitis
a type of arthritis that causes inflammation in the joints and ligaments of the spine
over time, can cause some of the bones in the spine (vertebrae) to fuse.
Ankylosing Spondylitis pain
Pain on and off, regardless of exertion
Progressive loss of range of motion
Alternating pain in the sacroiliac joints with walking
Later sign: gross bilateral limitation of side bending
Pain goes in vertical direction, not laterally or to the lower extremities
Stiffness in the morning eases with movement
No paresthesia
25% of people have an inflammation of the eye that worsens with exposure to bright light
Cauda Equina treament
CES is a devastating disorder and is considered a true neurologic emergency.
Treatment within the first 48 hours is correlated with better outcomes
cause of Cauda Equina
Commonly caused by atraumatic midline posterior disc herniation at the L3 – S1 levels
Cauda Equina pain
Bilateral severe pain or weakness in lower extremities
Saddle pain/paresthesia
Urinary and bowel incontinence (S4 nerve root is not affected)
Typically urinary retention is the symptom of reference. If present, sensitivity (.90) and specificity (.95); (+)LR 18 and (-)LR .01
Cancer pop
Previous history of cancer
Patient over 50 years of age with new onset of low back pain
Cancer symptoms
Unexplained weight loss
Night pain
Worsening pain
No response to conservative management
Sign of the buttock
Mnemonic “lead kettle” (PB KTLL) can be used for those cancers that frequently cause low back pain Prostate, Breast, Kidney, Thyroid, Lung, & Lymphoma
Infection symptoms
Fever
Recent bacterial infection
Recent lumbar spine surgery
Immunocompromised status
Night pain
Worsening pain
No response to conservative management
Central Sensitization pain
Though not a traditional “Red Flag”, these patients require medical management
Patients would be typically classified as chronic with a past history of episode(s) of back pain and an inability to heal
Widespread pain
Pain does not follow anatomical pattern
High psychological distress
Pain disproportionate to provocation and easing tests
Hypersensitivity to light touch
what are Yellow Flags
Proceed with Caution
Musculoskeletal disorder that can be treated but there is an underlying medical or psychological issue that may need co-management or outright referral.
Angina pectoris
chest pain or discomfort that keeps coming back.
Arthritic conditions with LBP
Rheumatoid arthritis
Osteoarthritis
Endocrine conditions associated with lower back pain
Thyroid
Cardiovascular conditions
Hypertension
Hyperlipidemia
Angina pectoris
Atherosclerosis
Hyperlipidemia
an excess of lipids or fats in your blood
Gastrointestinal conditions
associated with LBP
Constipation
Metabolic conditions
associated with LBP
Diabetes
Neuropathies associated with LBP
Musculoskeletal conditions
Irreducible disk lesion
Congenital spine pathologies
Pulmonary conditions associated with LBP
Asthma
Coughing
Chronic obstructive pulmonary disease
Psychological Comorbidities Associated with LBP
anxiety and depression
2 item depression screen for anxiety or depression
Over the past 2 weeks, have you felt down, depressed or hopeless?”
“Over the past 2 weeks, have you felt little interest or pleasure in doing things?”
psychosocial factors is a term used to describe characteristic of patients that BLANK
that pose risks of poor treatment outcomes
Fear of Movement
The anxiety that many individuals with persistent pain experience regarding engaging in activities or physical movements
Pain Catastrophizing
the tendency to describe a pain experience in more exaggerated terms than the average person, to ruminate on it more, and/or to feel more helpless about the experience
how to test fear of movement
FABQ – 16 item screen with 2 subsections
Tampa Scale of Kinesiophobia – 17 item screen which measures fear of LBP
how to test Pain Catastrophizing
Pain Catastrophizing Scale – Assesses the extent of catastrophic cognitions
what does the OREBRO find
early ID of persitant back problem
The total score was a relatively good predictor of future absenteeism due to sickness as well as function, but not of pain.
what is the STarT Back
9 item screen to predict the progression to chronic status
