Red Flags Flashcards
What are some emergency MSK conditions?
What are some symptoms to look out for?
Cauda equina syndrome (CES)- People presenting with spinal pain and leg pain with neurological symptoms and with any suggestion of changes in bladder or bowel function or saddle sensory disturbance, should be suspected of CES.
Metastatic spinal cord compression (MSCC)- MSCC occurs as a consequence of metastatic bone disease in the spine. It can lead to irreversible neurological damage. Symptoms can include spine pain with band like referral, escalating pain and gait disturbance.
Spinal Infection – may present with spinal pain, fever and worsening neurological symptoms consider risk factors (e.g immunosuppressed, primary source of infection, personal or family history of tuberculosis).
Septic arthritis- if the person presents who is unwell, with or without a temperature, with a sudden onsetof a hot swollen painful joint, with multidirectional restriction in movement, septic arthritis should be expected until proven otherwise. This is particularly important in children, where this may not present as hot swollen painful joint but instead as painful limp or loss of function in the upper limb
What are some urgent MSK conditions requiring referral?
What are some symptoms to look out for?
Primary or secondary cancers- Metastatic disease as a consequence of primary cancers such as breast, prostate and lung cancer can metastasise to the spine. May present with escalating pain, night pain and may describe symptoms as being unfamiliar, eventually becoming systemically unwell. If becomes systemically unwell needs to be escalated to local emergency pathway
Insufficiency fracture -Commonly presents with sudden onset of pain, mostly located in the thoraco-lumbar region following low impact trauma. The pain varies in presentation, but is often severe, and mostly localised to the area of the fracture.
Major spinal related neurological deficit –Commonly with spinal pain and associated limb symptoms.A person with new onset or progressively worsening limb weakness, present for days/weeks, less than grade 4 on the oxford scale associated with 1 or more myotome.
Cervical spondylotic myelopathy (CSM) - In rare cases cervical spondylosis can progress to this condition. Consider CSM if patients present with pain getting worse, lack of co-ordination e.g. trouble with tasks like buttoning a shirt, heaviness or weakness in arms or legs, pins and needles and pain in arms, problems walking, loss of bladder or bowel control
Acute inflammatory arthritis and suspected rheumatological conditions - myalgia, persistent synovitis, new onset autoimmune CT disease, new onset headache, suspected infammatory spina pain.
