MSK
RED FLAGS

Cauda Equina
Dysfunction

  • bladder, bowel, sexual function
    Sensory changes
  • saddle or peri-anal areas
    Gait disturbances

CANCER/TUMOUR

  • atypical swelling + or - pain
  • pain with no history of trauma
  • unremitting/increasing pain
  • weight loss
  • history of cancer
  • systemically unwell
  • night pain/disturbed sleep
  • localised tenderness

TRUAMA, INJURY, DISLOCATION

  • loss of movement + abnormal shape\deformity
  • unremitting pain at site
  • reduced movement & activity
  • red, swollen, bruised
  • minor trauma + history of osteoporosis

DEEP VEIN THROMBOSIS

  • calf oedema
  • red, hot limb
  • painful, often behind knee
  • feet cyanotic - deep red/purple

INFLAMMATORY ARTHROPATHY

  • morning stiffness - backache, multiple joint pains/stiffness
  • not improved with rest
  • generally unwell
  • associated - skin rash, bowel disease, eye problems, urethritis
  • sacroiliac pain or tenderness
    Blood results
  • positive C-reactive protein (CRP)
  • ESR elevated
  • Plasma viscosity
  • HLA B27 - positive

INFECTION OR INFLAMMATION

  • loss of movement + abnormal shape/deformity
  • pain - persistent, throbbing for infection
  • movement reduced both active & passive
  • redness, warmth, oedema
  • minor trauma, osteoporosis

CHARCOT FOOT

  • red, hot, swollen
  • neuropathy
  • unexpected pain with neuropathy
  • sudden change in shape
  • diabetes

SEPSIS

  • infection - known or suspected
  • respiratory rate >20 breaths per minute
  • heart rate >90 beats per minute
  • temperature <36 or >38
  • altered mental state

MYELOPATHY
Upper Motor Neurone Lesion

  • insidious progression
  • decreased sensation - non-dermatonal
  • weakness - non-myotomal
  • gait alteration - ataxia
  • hands - clumsy, weak
  • neurological changes in upper & lower limbs

TESTS
Hyperreflexia

  • reflexes over responsive
    Clonus
  • uncontrollable rhythmic & shaking
    Babinski reflex
  • positive - hallux extends & dorsiflexes
    L'hermitte's sign
  • pain down back of neck when trying to put chin to chest
    Hoffman's sign
  • thumb/forefinger move after being flicked

RED FLAGS

  • assessment & differential diagnosis to exclude serious pathology
  • raise index of suspicion
  • increased if >1 present
  • holistic approach <1% will have serious problems

Requires -
emergency hospital admission

  • may require emergency surgery
    Send to
    A&E

Send to
GP
or
A&E

Send to
A&E

Send to
A&E

Refer to
Rheumatologist

Refer to
GP

Send to
A&E

Send to
A&E
999 if necessary

Refer to
neurologist
or GP