Upper Quarter Red Flags

Question 1

fractures/dislocation S/Sx

Answer 1

• trauma, sufficient energy exchange (MVA, falls, direct blow or impact)
• severe limitations of motion all planes (muscular spasm, unwillingness to move)
• deformity may be present
• must be ruled-out by diagnostic imaging

Question 2

spinal neoplasm S/Sx

Answer 2

• medical history (+) for cancer, even if cleared or thought to be in remission
• night pain/other atypical pain manifestations
• worsening pain
• unexplained weight loss
• fatigue, malaise, unwellness
• no response to conservative management
• inconsistent reproduction of neck pain

Question 3

inflammatory/systemic disease S/Sx

Answer 3

• body temperature > 100°F
• blood pressure > 160/95 mmHg
• resting pulse > 100 bpm
• resting respiration > 25
• redness, warmth, swelling
• discoloration (e.g. jaundice)
• fatigue, malaise, unwellness
• Hx of past infection
• post surgical complaints

Question 4

referred cardiac pain

Answer 4

• left chest, neck, arm pain
• jaw, posterior thorax (T3/4 - T7), epigastrium pain
• classically left-sided/C8 distribution
• angina
• associated symptoms: dyspnea, LE edema, SOB, fatigue, syncope

Question 5

referred gall bladder pain

Answer 5

• recurrent right thoracic/lower rib region, right inferior scapular region
• increased intensity following meals (fatty, greasy foods tend to worsen Sx)
• at risk → obese women in 40s
• associated Sx → nausea/heartburn, vomiting/diarrhea, difficulty swallowing, jaundiced, rectal bleeding/stool changes

Question 6

referred lungs and associated structures pain

Answer 6

• thoracic and chest regions
• possibly cervical region/shoulders (pancost tumors)

Question 7

referred pulmonary disease pain

Answer 7

• rarely manifests purely as pain
• infections, pleurisy, cancer
• difficulty with respiration, cough
• hoarseness, sore throat, wheezing
• “I feel like my lungs are rubbing against something.”

Question 8

5 D’s and 3 N’s

Answer 8

• dizziness
• diplopia (double vision)
• dysphagia
• dysarthria
• drop attacks
• nystagmus
• nausea/vomiting
• numbness/paresthesia

Question 9

red flags symptomatic concerns (besides 5 D’s and 3 N’s)

Answer 9

• headaches (headache + neuro Sx = stroke)
• facial Sx
• altered consciousness
• quad/hemiparesis
• gait/balance disturbances
• multi-segmental weakness

Question 10

compressive cervical myelopathy

Answer 10

• more common in cervical region than thoracic region
• any neurological deficits resulting from compression of spinal cord in cervical spine
• gait and balance disturbances, generalized weakness (“I’m falling”)
• may not be associated with any radiating pain (bilateral pain/numbness in arms and/or legs, may have local radicular involvement)
• (+) signs of UMN involvement (Hoffman’s, Babinkski, hyper-reflexic DTRs, Clonus)