Week 1- Medical Screening and Low Back Pain Flashcards
Evaluation/Intervention Components
1) Medical screening
2) Classify condition
Aspects of medical screening
- Appropriate for PT evaluation and intervention
vs
- Appropriate for PT evaluation and intervention WITH consultation w/ another health care provider (YELLOW FLAGS)
vs
- Not appropriate for PT evaluation and intervention (RED FLAGS)
What happens in component 2: classify condition
Classify through evaluation of clinical findings of MSK impairments and associated tissue pathology
What is the most common site of metastases?
The skeleton
What percentage of metastases are in the lumbosacral region?
40%
What metastatic cancer commonly causes lumbar spinal pain?
In prostate
Sensitivity and specificity
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What symptoms may indicate a back-related spinal infection?
- LBP, flank, or pelvic pain
- Tenderness over spinal process w/ percussion
- Concurrent infection or drug use
- Fever
What is cauda equina syndrome?
- Compression and swelling of the cauda equina
- Neurologic emergency
- Surgery most successful w/in 72 hours
Symptoms of cauda equina syndrome?
- Urine retention
- Saddle anesthesia
- Sensory/motor deficits in the feed (L4, L5, S1 areas)
Symptoms of spinal compression fracture
- Major trauma
- Pain and tenderness
- Age > 50
- Female
Symptoms of an abdominal aortic aneurysm
- Midline lower thoracic/lumbar pain (may be asymptomatic at time of diagnosis)
- Palpable pulsating abdominal mass
- Pain descriptors: throbbing, pulsating
- Patient unable to fiind comfortable position
- Hx of cigarette smoking
- Positive family hx
- History of AAA, vascular atherosclerotic disorders
What is ankylosing spondylitis?
- An inflammatory arthropathy
- Systematic rheumatic disorder
Risk factors for ankylosing spondylitis
- Males > Females
- Hx of inflammatory conditions (IBS, Crohn’s)
Symptoms of ankylosing spondylitis
- Morning stiffness > 30 min
- Improve LBP w/ exercise but not rest
- Night pain during 2nd half of night
- Alternating buttock pain
ID the GI Referral Patterns
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Characteristics of cluster 1 to signify abdominal pain of MSK origin
- Coughing sneezing, or taking a deep breath makes pain worse
- Bending, sitting, lifting, twisting, turning over in bed makes pain worse
- No change in bowel habit since symptoms came
Characteristics of cluster 2 to signify abdominal pain of MSK origin
- Eating certain foods does not make pain worse
- Weight has not changed since symptoms started
ID renal/urinary referral patterns
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Questions for renal/urinary disorders
- Do you have any trouble with urination?
- Ask about changes in urine color, initiation, incontinence, flow changes
Symptoms in reproductive system to be aware of in males
- Urethral discharge
- Sexual dysfunction
- Pain during intercourse/ejaculation
Symptoms in reproductive system to be aware of in females
- Vaginal discharge
- Pain w/ intercourse
- Menstruation
- Frequency
- Length of cycle
- Dysmenorrhea
- # of pregnancies and deliveries
- Menopause
Common risk factors for depression
- Current/past hx of major depression
- Family hx of depression
- Hx of MI, CA, CVA, substance abuse/dependency, obesity, CHF, dementia, or DM
- Significant loos/change in social status
- Pregnanty/post-partum
- Fatigue/sleep disturbance
- Weight change
- Women > Men
- Chronic pain/2+ chronic diseases
Most important questions to ask patients about depression
- Past 2 weeks, felt down, depressed, or hopeless?
- Past 2 weeks, little interest or pleasure in doing things?
What are red flags in a PT practice?
Signs and symptoms that raise suspicion of serious spinal pathology
Levels of concern
- No concerning features
- Few concerning features
- Some concerning features
- Many concerning features
Decision for no concerning features
- Begin a trial of therapy
- Revise management if clinical features change unexpectedly
Decision for few concerning features
- Begin a trial of therapy with watchful waiting
- Revise management if clinical features change unexpectedly
- Monitor progress closely (vigilance)
Decision for some concerning features
- Urgent referral
- DO NOT begin a trial of PT
- Further investigation or referral is warranted
Decision for many concerning features
- Emergency referral
- DO NOT begin a trial of PT
- Emergency referral is warranted
Red flags to watch out for
- Cauda equina syndrome
- Spinal fracture
- Spinal malignancy
- Spinal infection
