Red Flags

Red Flags

Cord
1. symptoms
  1. gait disturbances
  2. bilateral/quadrilateral/unilateral paraesthesia
  3. bladder & bowel dysfunction
    1. urinary & faecal incontinence, urinary retention
  4. hyperreflexia may be present
2. signs
  1. Babinski
    1. normal-all toes plantarflex
    2. abnormal-D/F big toe P/F other toes
  2. Clonus
    1. + response-intermittent contract & relax with sustained TA stretch
    2. Gastrocs tested, knee straight
Cauda Equina
1. Symptoms
  1. bladder/bowel sphincter weakness
    1. urinary & faecal incontinenece, sexual dysfunction
2. Signs
  1. Saddle anaesthesia/paraesthesia
  2. Hyporeflexia
VBI
1. Symptoms
  1. 5 Ds
    1. Dizzines
    2. Diplopia-double vision
    3. Drop attacks
    4. Dysphagia-swallowing
    5. dysarthria-speech
  2. 3 Ns
    1. Nystagmus- rhythmical oscillations of the eyeballs
    2. Nausea
    3. Numbness- facial/ oral
2. Screening
3. Provocative testing
  1. minimum test
    1. end range Cx rotation to left & right
      1. 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
Special Questions
1. general health-DEARTHCO
2. Cord
3. Cauda/ Dizziness
4. Medication
5. steroids
6. unexplained weight loss
7. tests & investigations
8. night pain
severe pain in <25/>55
recent trauma- possible fractures
Constant pain- inflammatory/ malignancy
Contra-indications to mobilzations
1. Malignancy-vertebral column
2. Cord/ Cauda Equina signs/symptoms
3. active inflammatory & infective arthritis
4. diseases of the spinal cord
5. fracture
6. VBI
Thoracic pain-visceral pathology eg. cardiac
hx of malignancy- possible recurrence
prolonged corticosteroid use- decrease bone density
night pain-malignancy (esp. 3 hrs into sleep), inflammatory
night sweats/ fever-infection, TB
widespread neuro symptoms-multiple level neuro involvement
structural deformity-fracture
unexplained weight loss >10 % pts body weight under 6 months

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	Created by oz.dawjee about 10 years ago