red flags & serious spinal pathology Flashcards
what is red flag screening?
process of identifying serious underlying medical conditions that may require urgent medical attention rather than physiotherapy alone
in terms of breast Ca, what is important to know in terms of red flags?
-85% chance of developing bony mets before death
-earliest sites for bony spread are the spine especially thoracic
-family history NB
what is a red herring?
Red herrings are misleading symptoms or findings that might distract the physiotherapist from the actual diagnosis. They can lead to incorrect assumptions or unnecessary concern.
eg normal age related changes
eg chronic LBP in a person who says they have weight loss due to dieting
what do you do if you pick up red flags and have concerns over a potentially serious spinal pathology?
-refer/escalate care to a specialist early
-care pathways in many sites
-consider scope of practice
what are the 4 spinal red flags?
-cauda equina syndrome
-spinal fractures
-spinal infection
-malignancy
what is the cauda equina?
a bundle of spinal nerve roots from the lower end of the spinal cord in the lumbar spine
what is cauda equina syndrome?
a spinal surgical emergency that lead to lower limb paralysis and loss of bowel, bladder, sexual function if not assessed and treated early
what are risk factors for CES?
-herniated / prolapsed disc
-spinal stenosis
-spinal tumours
-spinal infections or inflammation
-major injuries to the lower back
-complications to spinal surgery
-spinal anaesthesia
describe sexual dysfunction associated with CES?
-vaginal anaesthesia and numbness
-incontinence during intercourse
-intensity or inability to achieve orgasm
-inability to achieve erection
what is complete vs incomplete CES
what would go under high clinical suspicion for spinal fractures in patients with back pain?
-history osteoporosis
-history of trauma
-history previous fracture
-corticosteroid use
-history specific Ca eg breast, prostate, lung, thyroid etc
-female
-older age
-thoracic pain
what would be under low clinical suspicion for spinal fracture in patients with back pain?
-no fam history osteoporosis or fracture
-no previous fractures
-no other osteoporotic risk factors
what % of spinal fractures go undiagnosed?
70%
what are risk factors for spinal infection?
-immunosuppression
-pyogenic infection eg after UTI/GI/skin
-IV drug use
-surgery
-social and environmental factors
-history TB or HIV
what are symptoms of a spinal infection?
-localised progressive pain that limited movement ++
-bilateral neurological symptoms
-level of fatigue that is abnormal for them
-fever
-loss of 5% of body weigh over 3-6 months
what are spinal masquerders?
any pathology in the chest/abdomen/thorax can have the potential to refer to the spine and can to an extent mimic MSK pain
what can visceral referred pain be reported like?
-deep diffuse, hard to localise
-pai behaviour will relate to visceral function eg CVS exertion or GI digestion
in terms of malignancy, what would a red flag be?
if age is >50, history of Ca + unexplained weight loss + failure to improve after 1 month of conservative therapy
what are some warning signs for malignancy?
-unusual bleeding or discharge
-sores that dont heal
-thickening or lump
-indigestion or difficulty swallowing
-change in mole or wart
-change in bowel or bladder habits
where is most common in the spine for mets?
-thoracic
-lumbar
-cervical
what are symptoms of an abdominal aortic aneurysm?
-65 years +
-syncope
-bacl pain - LB or abdominal or groin - severe
-abdominal pulsing
what are examples of neurological deficit with spinal cord compression patients?
-pins + needles
-weakness
-trips / falls / problems walking
-reduced dexterity
-continence / bowel / bladder
