Spinal cord subjective assessment Flashcards
Outline a few of the key aims of a subjective assessment.
Hypotheses for the source of symptoms.
Estimate SIN
Identify any precautions or contraindications
Develop a management plan
Describe a general subjective assessment.
Body PC HPC PMH DH SH
Can you identify and explain each flag used as part of the flag system for msk?
Red flags- biomedical factors
Yellow factors- Psychological factors
Blue flags- social and economic factors
Black flags- occupational/ work factors
State a few red flags for a spinal cord injury and explain what you do during red flag screening of the spinal cord.
Red flag screening of spine:
Sub classify PC into serious spinal pathology, nerve root pathology and non specific spinal pain.
General Spinal red flags are: Age of consent Constant progressive pain Night pain Unexplained significant weight loss of 5-10% Thoracic pain Structural deformity Violent trauma Systematic steroids Drug abuse PMH of cancer
Tell me a few spinal cord compression red flags.
Clumsiness of extremities Stumbling gait L 'Hermitte' sign Unilateral or bilateral para/anaesthia Bowel or bladder dysfunction
Red flags Metastases
History of 5-10% weight loss over 6 months regularly
PMH cancer
Age over 50
Failure of treatment for a year
All 4 red flags usually indicate spinal cancer.
Red flags spinal fractures
Age over 50
Trauma
History of systemic steroids
Score of over 9 on sensitivity
Red flags spinal inflammatory disorders
Morning stiffness on a certain area of the spine
Gradual onset before age of 40
Peripheral and spinal joint stiffness in all directions
Skin rashes
Collitis or irritis
Family history
High erythroycyte sedimentation rate
Red flags for spinal infection
Systemically unwell Recent bacterial infection IV drug abuse Immunosuppression (steroids) PMH of : TB, HIV, injection drug abuse, catheterization and diabetes
Red flags cervical arteriol
Dizziness Diploplia Dysarthia Dysphagia Drop attacks Nausea Numbness (face) Nystagmus Headaches
Internal causes of thoracic pain
Pleurisy Pancoast's tumour Neoplasm TB Aortic aneurysm Hiatus hernia Angina pectoris Gall bladder, kidney and stomach
Explain these 3 unhelpful psychosocial factors fear avoidance, catastrophising and pain behaviours.
Fear avoidance- is fear of participating in an activity as a person believes it will cause pain.
Catastrophising- severe irrational beliefs about a negative situation that spin out of control.
Pain behaviours- avoiding doing something or doing altered movements to compromise not doing a movement.
What questions could you ask whilst carrying out a yellow screening assessment on a patient?
Have you had anytime of work because you have hurt your back?
What do you think is the cause of the back pain?
Are you worried or concerned about anything?
See notes for more
Explain a few questions to ask during blue or black screening?
How does your posture change at work?
Could you lift this weight for me so I can see what your posture is like at the gym?
Does the playing tennis make the site of pain change?
Is there any specific tasks at work that are more aggravating then others.
