Red/Yellow Flags Flashcards
Name 5 red flags according to Mennell
Smallpox, Influenza, Genitourinary symptoms, Prostate cancer, acute kidney problems, MS, Parkinson's Disease, TB, Paget's Disease, Appendicitis, Sepsis - Bowel, Teeth, Tonsillitis, Hemorrhoid
Name 5 red flags according to Cyriax
Backache with fever, Neoplasm, Root pain > 8 months of duration or with gross limitation of every movement, weak psoas major, afebrile, osteomyelitis, aortic occlusion, spinal claudication, STD Fasciitis, Multiple Root Palsy, Forbidden Area (TL junction) pain
Current Subjective findings that are red flags for patients are:
Gradual increase in pain with prolonged time versus disc pattern,
Expanding pain to multiple segments,
Elderly patient - presentation of rapid increase in pain or stiffness over 1-2 months,
Pain increases by cough,
Paresthesia all over body provoked by neck flexion,
Cord symptoms,
History of cancer
Current Objective Articular Findings that are red flags are:
Painful restriction - full articular pattern over a short period of time,
Gross limitations of sidebending,
End Feel - Soggy, empty, or muscle spasm
Current Objective Non-Articular Findings that are red flags are:
Unusual myotome involvement: excessive loss of power, 2-3 nerve root signs and symptoms, painless weakness, fatigable weakness, painful resisted weakness,
Distal before central symptoms
Anemia
Guidelines for red flags acccording to Waddell in 2004
Age less than 20 or greater than 50, History and/or signs of serious trauma, History of Neoplasm, Fever, Neurological Deficits
The CSAG and AHCPR red flags are
Age of onset greater than 50 rather than greater than 55,
Pain that worsens in supine,
Severe Night Pain
In the sign of the buttocks, hip flexion PROM is just as limited as _________ and _______ ranges of motion
SLR, trunk flexion
In the sign of the buttock there is painful weakness of hip ________
extension
The sign of the buttock follows a _____ -_________ pattern of the hip
non-capsular
______ in the buttock is unusual and is considered part of the sign of the buttock
swelling
Having an empty end feel in ______ is part of the sign of the buttock
flexion
Possible conditions associated with the sign of the buttock include:
Rheumatic Bursitis, Osteomyelitis of the upper femur, Neoplasm of the upper femur, Neoplasm of the ilium, Fractured sacrum, Ischiorectal Abscess, Septic Sacroiliitis, Septic Bursitis
These tests are misconstrued as the sign of the buttock
Kernig/Brudzinski Signs
Brudzinski’s sign involves passive ________ flexion and produces flexion of the ______ and ________
neck, hips and knees
Brudzinski’s sign is only seen in _______ cases of meningitis
severe
Kernig’s sign involves passive extension of the _______ while the ______ is flexed
knee, hip
Brudzinski’s sign involves passive neck _______ and produces _______ of the hips and knees
flexion, flexion
Kernig’s sign involves passive _______ of the knee while the hip is _________
extension, flexed
An aortic aneurysm is a _______ in the blood vessel
bulge
An AAA is induced by ______ ________ of the aortic wall that causes a dilation or ballooning of the blood vessel
progressive weakening
AAA typically takes place in what location?
under the kidneys
Although less common you can have a _______ Anerysm
thoracic
AAA can be caused by ____ _____ ______ such as Marfan’s Syndrome
Inherited genetic illnesses
Possible causes of AAA include
Emphysema, smoking, obesity, male gender, substantial blood pressure, genetic elements high cholesterol
Name 5 Signs and Symptoms of AAA
Hoarseness, Bowel Obstruction, Chest or back discomfort, discomfort in the jaw, neck, and upper back, increased HR when going to a standing position, excess weight loss, nausea, vomiting, clammy skin, coughing up blood, anxiousness, difficulty swallowing, coughing, difficulty breathing
Treatment of AAA is typically
Stenting
Most caudal roots arising from the lumbar spine are ________
separate
Management of cauda equina is often _______ and ______
difficult and prolonged
The cauda equina usually terminates at the ______ disc but may go as far from ______ to _____
L1/2 disc
T12 body to L3/4 disc
The caudal spinal cord is termed the
conus medullaris
The conus medullaris is continuous as a filament below the cauda equina known as the
filum terminale
The dura and arachnoid meninges surround the filum terminale to the level of the ______ body
S2
The first and second lumbar nerve roots has an angle of approximately __ to ___ degrees
70-80
The third and fourth lumbar nerve roots have angulations of ___ degrees
60
The fifth lumbar nerve root has an angle of __ degrees
45
The first sacral nerve root has an angle of __ degrees
30
The cauda equina can be impinged by
disc protrusion centrally,
tumor,
trauma
Symptoms of cauda equina include:
Loss of bowel and bladder patency, LE weakness or loss of sensation, Saddle anesthesia, Low back pain, Loss of reflex signs (lower motor neurons)
Management of caude equina is a _________ _________
medical emergency
Cauda equina needs to be surgically managed in ______ hours to be successful
48 hours
Sensitive signs of Cauda Equina according to Dayo et al include
urinary retention,
unilateral/bilateral sciatica,
Sensory/Motor Deficits and reduced SLR,
Saddle Anesthesia
Signs and symptoms of Cauda Equina according to Ng et al include
Perineal Numbness, Loss of Urinary Sensation, Urinary Incontinence, Absent Anal Tone, Fecal Soiling, Painful retention, And Fecal Incontinence
Any Pathology in the abdomen can present with _______ _______
back pain
Simple _____ or ______ pain can mimic the pain of angina
thoracic or TL junction
______ pain can be produced by multiple organs
thoracic pain
Headaches are often _____ but occasionally _____
benign, serious
Cancers most common in men and women
Stomach, lung men
Breast, cervix women
Recognition of red herrings is often dependent on _____, ______, and _______ rather than rules
awareness, vigilance, and suspicion
Do not over rely on red flag lists as they are clinical ______ but not absolute _____
indicators, rules
95% of the time its a ______ ______ _____ but 5% have ______ related pain and 1% have ______ ______ ______ related to back pain
simple back ache, nerve, serious spinal pathology
Yellow Flags Include:
Exaggerated Responses (Waddell), "wrong" amount of activity, High stress, anger, Increased static muscle tone, poor posture, Poor diet, Exercise Habits, Excessive medications, Litigation
Yellow flag disorders include:
RA,
Osteoporosis,
Malignancy,
Dizziness
Rheumatoid arthritis may lead to
ligamentous weakness and osteoporosis
Current or long term use of anticoagulants or steroids can cause
bone absorption and ligamentous weakness
These bones are especially vulnerable with osteoporosis
ribs
These techniques must be used with care in osteoporosis
pressure techniques
Osteoporosis is seen more commonly in
Menopausal women,
Laxative users,
Post gastrectomy,
Anticoagulant users
In patients with malignancy careful ______ is not contraindicated as long as the possibility of metastasis has been thoroughly investigated and ruled out
mobilization
You should be careful with dizziness if it is produced or aggravated by_____ _____ and this contraindicates the techniques involving _____
neck rotation, rotation
Osteoporosis must be ______ before it is noted radiographically
severe
When treating children, care needs to be taken with the _______, in areas of ______ ______
growth plates, incomplete ossification
