Red Flags

Red Flags

1. Cord

   • symptoms
     • gait disturbances
     • bilateral/quadrilateral/unilateral paraesthesia
     • bladder & bowel dysfunction
       • urinary & faecal incontinence, urinary retention
     • hyperreflexia may be present
   • signs
     • Babinski
       • normal-all toes plantarflex
       • abnormal-D/F big toe P/F other toes
     • Clonus
       • + response-intermittent contract & relax with sustained TA stretch
       • Gastrocs tested, knee straight

2. Cauda Equina

   • Symptoms
     • bladder/bowel sphincter weakness
       • urinary & faecal incontinenece, sexual dysfunction
   • Signs
     • Saddle anaesthesia/paraesthesia
     • Hyporeflexia

3. VBI

   • Symptoms
     • 5 Ds
       • Dizzines
       • Diplopia-double vision
       • Drop attacks
       • Dysphagia-swallowing
       • dysarthria-speech
     • 3 Ns
       • Nystagmus- rhythmical oscillations of the eyeballs
       • Nausea
       • Numbness- facial/ oral
   • Screening
   • Provocative testing
     • minimum test
       • end range Cx rotation to left & right
         • Maintain EROM position- 10 sec
           • 10s held @ EROM left rotation- then to neutral 10s-observe
             • then other side
               • Hold @ EROM rotation 10s UNLESS symptoms reproduced sooner
                 • looking for 5Ds & 3Ns

4. Special Questions

   • general health-DEARTHCO
   • Cord
   • Cauda/ Dizziness
   • Medication
   • steroids
   • unexplained weight loss
   • tests & investigations
   • night pain

5. severe pain in <25/>55

6. recent trauma- possible fractures

7. Constant pain- inflammatory/ malignancy

8. Contra-indications to mobilzations

   • Malignancy-vertebral column
   • Cord/ Cauda Equina signs/symptoms
   • active inflammatory & infective arthritis
   • diseases of the spinal cord
   • fracture
   • VBI

9. Thoracic pain-visceral pathology eg. cardiac

10. hx of malignancy- possible recurrence

11. prolonged corticosteroid use- decrease bone density

12. night pain-malignancy (esp. 3 hrs into sleep), inflammatory

13. night sweats/ fever-infection, TB

14. widespread neuro symptoms-multiple level neuro involvement

15. structural deformity-fracture

16. unexplained weight loss >10 % pts body weight under 6 months