red flags

Question 1

What are the initial steps and key warning signs to look for in primary care orthopaedic assessment that suggest serious pathology?

Answer 1

Initial assessment includes a thorough history of the presenting complaint and medical history (trauma, cancer, immunosuppression, medications), and a musculoskeletal and neurological examination.

Crucial warning signs (red flags) suggest serious pathology and may require referral or specialist advice.

History Red Flags:
Local: Rapidly progressive symptoms, Red/hot/swollen joint, Pain interrupting sleep.

Systemic: Loss of appetite, Loss of weight, Fever, Change in bowel or bladder function, Weakness or change in sensation, History of cancer, History of intravenous drug use, Immunosuppression.

Examination Red Flags:

Fever > 38°C.
Inability to bear weight on a joint.
Red/hot/swollen joint.
Saddle anaesthesia.
Lower motor neuron signs.
Reduced anal tone.
Bilateral upper motor neuron signs.

Question 2

What are the red flags on history taking during the initial assessment?

Answer 2

History red flags:

Local: Rapidly progressive symptoms, Red/hot/swollen joint, Pain interrupting sleep

Systemic: Loss of appetite, Loss of weight, Fever, Change in bowel or bladder function, Weakness or change in sensation, History of cancer, History of intravenous drug use, Immunosuppression

Question 3

What are the red flags on examination during the initial assessment?

Answer 3

Examination Red Flags:

Fever > 38°C.
Inability to bear weight on a joint.
Red/hot/swollen joint.
Saddle anaesthesia.
Lower motor neuron signs.
Reduced anal tone.
Bilateral upper motor neuron signs.

Question 4

What are the red flags for masses or lesions that suggest possible malignancy and what would be the next step ?

Answer 4

Malignant tumours of soft tissue and bone should be excluded in patients with a mass or lesion showing specific characteristics.
•
Red flags for masses:
-Rapid growth.
-Pain.
-Diameter > 5cm.
-Located deep to fascia.

Next step: Imaging (ultrasound for soft tissue, radiograph for bone) and specialist referral are the next steps.

Question 5

What are the red flags for infections like septic arthritis or osteomyelitis?