Red flags

Published: 02/11/2020

These are important things to remember to direct your subjective questioning to rule out any serious pathologies mascrading as another problem. Each area of physio has different red flags. I have listed some of them below by speciality. 

Musculoskeletal

Lumbar spine

Cauda equina

• Loss of sphincter tone
• Altered S4 sensation (saddle anaesthesia or paraesthesia)
• Bladder retention or bowel incontience
• Disturbed gait
• Bilateral pins and needles in the legs, present below the knee

Watch the video below for more details on cauda equina red flags, symptoms and actions you should take if you identify it.

Ankylosisng spondylitis

• Familt history
• Onset between 20 to 40 years
• Male (incidence male: female = 3.5:1)
• Worsening night or early morning stiffness (more than 30 minutes to ease)
• Rest = worse
• Activity = better
• Other rheumatological conditions: Crohn's, psoriasis etc

Upper motor neuron lesion

• Gait disturbance
• Loss of co-ordination
• Spasms
• Hyperreflexia or Hyporeflexia (bilateral)
• Loss of selective motor control

Spinal infection

• Recent or repeated infections
• Reports feeling unwell, has a temperature or a fever
• Has other co-morbities 

Cancer

• under 20 or over 55
• Constant, progressive, non-mechanical symptoms
• Thoracic pain (can be 'band like' or unilateral)
• Night pain
• Abdominal pain
• Previous history of Cancer, Drug abuse, HIV, steroids or family history of cancer
• Systemically unwell (fever, exhaustion, weight loss)
• Multi-level neuro changes

5 most common cancers to metastasise to the bone

1. Thyroid
2. Breast
3. Lung
4. Prostate
5. Kidney

Remember: BLT with KP sauce

(Clinical Physio, 2020b)

Cervical Spine

Fractures

• Trauma
• Elderly (think osteoporosis)

Upper cervical instability

• Trauma
• Rheumatoid arthritis, ankylosis spondylitis, connective tissue disorders (e.g. Marfan's) or Down's syndrome
• Feeling of laxity
• Inability to hold head up
• Significant muscular tension
• Occipital headaches
• Pain (neck pain and referred, radicular or myelopathy distribution of pain)

Myelopathy

• Weakness and sensation changes in arms and hands (e.g. clumsy hands, wasting etc)
• Gait disturbance
• Loss of balance
• Co-ordination changes
• Changes to bowel and bladder (Clinical Physio, 2020b)

Summary

References

Clinical Physio (2020) Lumbar Spine red flags Handbook (available on their website in the shop).

Clinical Physio (2020b) Cervical spine Red flags handout and workbook (available on their website in the shop).

Link to Clinical Physio handbooks: https://learningtobeaphysio.blogspot.com/2020/10/red-flags.html