Medical Screening for Red Flags in the Diagnosis and Management of Musculoskeletal Spine Pain

Abstract

When a patient presents with pain in the different regions of the spine, the clinician executes a region-appropriate basic examination that includes appropriate historical cues and specific physical examination tests that can be used to identify red flags. The clinical tests include a specific examination of the sensory and motor systems. Test outcomes are best interpreted in context with the entire examination profile, where the sensitivity and specificity of these tests can influence their utility in uncovering red flags. These red flags can be categorized based on the nature and severity or the specific elements of the patient's presentation. Many general red flags can be observed in any region of the spine, while specific red flags must be categorized and discussed for each spinal region. This categorization can guide the clinician in the direction of management, whether that management is aimed at redirecting the patient's care to another specialist, reconsidering the presentation and observing for clusters of findings that may suggest red flags, or managing the patient within the clinician's specialty in context with the severity of the patient's presentation.

A screening questionnaire to predict no return to work within 3 months for low back pain claimants

“…Obstacles to recovery and return to work (RTW) usually fall under the categories red and yellow flags [10,20]. Persistent disabling symptoms may be prevented by early identification and modification of psychosocial factors that have been shown to be effective when implemented early in the course of back pain and play even an important role in the transition from acute to chronic LBP [9].…”

“…Multiple questionnaires are available for the assessment of LBP and disability, but only some address the problem of predicting which patients with LBP will develop longterm incapacity [6,8,20]. Most of these questionnaires have been set in the workplace or a primary care setting and require a long period for completion [7].…”

Physiotherapy-led triage clinic for low back pain

“…Physiotherapy assessment is completed accordin g t o st an dard medical procedure [15][16][17] and includes history of presenting condition, review of imaging and other investigations, past treatment for this problem, general medical history and investigation of red 18 and yellow flags 19 as a potential trigger for referral or further investigation. A comprehensive physical assessment is undertaken as appropriate.…”

Clinical Decision Making Associated With an Undetected Odontoid Fracture in an Older Individual Referred to Physical Therapy for the Treatment of Neck Pain

“…18 The patient complained of pain that was constant in nature and worst at night, which caused significant difficulty sleeping; pain that is constant and worst at night may indicate serious pathology. 6,16 The patient also had significantly limited active cervical spine range of motion and significant midline palpatory tenderness throughout the cervical spine, which may indicate cervical spine fracture. 19 Therefore, the decision was made to contact the referring physician to discuss the patient's history, physical examination, and radiographic findings and the possibility of an undetected serious cervical spine injury.…”