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MSK
RED FLAGS - Coggle Diagram
MSK
RED FLAGS
Cauda Equina
Dysfunction
- bladder, bowel, sexual function
Sensory changes
- saddle or peri-anal areas
Gait disturbances
Requires -
emergency hospital admission
- may require emergency surgery
Send to
A&E
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