MSK Red Flags

Question 1

What are common red flags for serious spinal pathology

Answer 1

Weight loss
Previous history of cancer
Night pain
Aged over 50
Violent trauma
Fever
Saddle anaesthesia
Difficult in micturation
Progressive neurology
Systemic steroid use

Question 2

What is micturation

Answer 2

Urinating

Question 3

What are possible serious spinal pathologies

Answer 3

Malignancy
Fracture
Infection
Cauda equina syndrome

Question 4

What are possible concerning pathologies

Answer 4

Sarcoma
MND
Ependymoma
Myeloma
Lymphoma
Chronic Lymphocytic Lymphoma (CLL)

Question 5

What are general red flags for long term MSK conditions

Answer 5

Bladder and bowerl dysfunction
Sudden weight loss (5% in last 3 months)
Age of onset (<20 years or >55 years)
Traumatic onset
Very high intensity of pain (8+ NRS)
irritable or easily aggravated pain
Duration / progression of symptoms
(constant unremitting or non-mechanical, progressive)
Pain location (headache, radiation, symmetry, multiple regions)
Diurnal pain pattern (increased pain at night at 2/3am, morning stiffness, > 30 mins)
Neurological symptoms (nerve conduction loss, history of TIAs)
Malaise
Recent infection / fever
Recent nausea / vomiting
Hx of cancer (especially lung, breast, colon, kidney and prostate in spinal pain)
Cardivascular hx (hypertension, atherosclerosis, clots, bleeds, etc.)
Hx of long-term corticosteroid use
Drug Abuse hx
HIV

Question 6

What are malignancy cervical spine red flags?

Answer 6

Malaise
Fever
Unexplained weight loss
Poor response to treatment >1/12
Unremitting pain
Localised tenderness over vertebral body

Question 7

What are infection cervical spine red flags

Answer 7

Fever
systematically unwell
immunosuppression
night pain
AIDS
TB

Question 8

What are inflammatory condition red flags for the cervical spine

Answer 8

Arthritis
Multi-joint pain
stiffness >1 hour in morning
Other inflammatory conditions
Wake up to pain

Question 9

What are red flags for cervical spine fracture

Answer 9

Trauma
Osteoporosis
? steroid use

Question 10

What are red flags for spinal cord compression (myelopathy)

Answer 10

Neurological symptoms
Insidious progression
gait disturbance
upper/lower motonueron signs
Loss of proprioception