Flags of MSK system Flashcards by Owen Honroth

systems review flow

cardiovascular
nervous
GI
pulmonary
urogenital
endocrine
psychological

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what are red flags

cue to a more serious medical pathology
indicates if referral is necessary

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how are red flags in isolation interpreted

most people will check at least one or two red flag boxes but they are only informative when multiple are indicated

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how are red flags used

management strategy not a screen

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what do red flags give us more information about, diagnosis or prognosis?

prognosis

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what do unilateral red flags indicate

heighten us to be aware of changes over time

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what is medical screening

process in which disease/condition is assessed in an asymptomatic population who may or may not have disease precursors

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what does screening allow for? when is it typically done?

guide whether or not diagnostic testing should be done

preclinical phase

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when is diagnostic testing done

when symptoms are present

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relationship between red flags and prognosis

little to no red flags = good prognosis

many red flags = not as good

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identification in patients when using 10 or 23 items of the OSPRO

10 - 95%
23 - 100%

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what does OSPRO stand for

optimal screening for prediction of referral and outcome

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if there is a yes reported on the OSPRO, what needs to be done by a therapist

asking more questions
- why? when? how does it change?

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what does the OSPRO provide

prediction of 12 month quality of life and comorbidity change

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those with more “yes” answers on the OSPRO need to

monitored - watchful wait approach

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what is watchful waiting effective in

avoidance of unnecessary imaging/surgery

improving patient rapport

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mortality vs morbidity

mortality - death
morbidity - illness or disease

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how to manage red flags as a clinician

utilize screening test/tools versus imaging to identify a need first

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what are red flag conditions determined by

demographics
previous family history
previous medical/surgery history
medications
macro vs micro trauma
symptom descriptions
location of the body

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structures that produce pain

somatic
visceral
neural

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superficial structures that can cause somatic pain

skin
fascia
tendon sheaths

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deep structures that can cause somatic pain

periosteum of bone
muscles
tendons
joints
deep fascia
capsules
dura

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description of somatic pain

dull
aching
gnawing
diffuse
multiple dermatomes

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characteristics of somatic pain

improve with rest/non-weight bearing

increases with activity

no constitutional symptoms

more predictable pattern of response to position, rest or activity

constitutional symptoms can be thought as

systemic symptoms

visceral pain characteristics

not well localized unpredictable pattern of response does not change with rest or nonweight bearing

what are the proposed visceral referred pain mechanisms

embryologic development multi-segmental innervation direct pressure and shared pathway

what is embryologic development mechanism of referred visceral pain

neural networks formed between organs due to the position of the organs in development will maintain through development when they separate

what is the multisegmental innervation mechanism of visceral referred pain

overlapping innervations that will refer pain to corresponding somatic area due to sensory fibers entering spinal cord at the same level

what is visceral organ cross-sensitization

multiple organs that have overlapping segmental projections have presentations of dysfunction

what is the direct pressure and shared pathway mechanism of visceral pain referral

pain is referred through shared ganglions from each organ's neural system where they gather and share information through the cord to the plexus

descriptors of neuropathic pain

sharp, shooting, burning, lancinating

how does brain tissue feel pain

it does not, it is insensitive to pain

which types of pain need nociceptive information

somatic and visceral

muscle pain description

cramping dull aching poorly localized

ligament or joint capsule pain description

dull aching

nerve root pain description

sharp lancinating shooting

nerve pain description

sharp lancinating lightening like

bone pain description

deep nagging boring dull localized

fracture pain description

sharp severe intolerable

vascular pain description

throbbing aching diffuse poorly localized

nocioplastic pain description

disproportionate to activity or mechanism of injury diffuse, non-anatomic areas

method of action when a low level of concern is present

begin a trial of therapy revision if clinical features change

method of action when there are a few concerning features

begin a trial of therapy with a watchful waiting mentality monitor progress or any changes in clinical presentations

method of action when there are some concerning features

urgent referral no therapy further investigation (referral)

method of action when there is a high level of concerning features

emergency referral do not begin therapy

types of yellow flags

pathological precautions psychological

psychosocial yellow flags

fear avoidance incorrect beliefs regarding exercise pain catastrophizing hypervigilance depression social withdrawal

clinical presentation of fear-avoidance behaviors

reluctance to participate in activities that may increase symptoms

clinical presentation of incorrect beliefs regarding exercise

belief that any exercise or movement that hurts a patient will cause more physical harm

clinical presentation of pain catastrophizing

constant ruminating on one's pain magnification of the threat that the pain poses

clinical presentation of hypervigilance

constantly on guard for threats to one's safety

yellow flag considerations

A - attitudes B - beliefs C - compensation D - diagnosis E - emotions F - family W - work

something to consider when thinking about diagnosis yellow flags

inappropriate communication can lead to patient misunderstanding of their medical condition

what measure and what score indicates a patient is at risk for chronic pain

orebro MSK pain questionnaire > 50 StarT Back = 4 or more

examination for pain catastrophizing? what score is significant?

PCS >30

what is the examination for kinesiophobia? what score is significant?

TSK-11 11-44, higher is more avoidant

what is the examination for avoidance behavior? what score is significant?

FABQ >34 for work >15 for physical activity