Assessing Red Flags

When a patient comes in for consultation we as physiotherapists have a duty to perform a careful history and examination to rule out serious problems and identify the cause of the symptoms. While most patients will have musculoskeletal conditions as an explanation of their symptoms, a small number will have a serious underlying condition of some kind. These people need identifying and referring urgently to a medical specialist for review. The medical community has developed a series of routine enquiries to be performed at consultation and these are referred to as flags in the sense that they should bring immediate attention to the matter.

Red flags has been developed as a concept which expresses an increased risk on examination that serious pathology is present although often in reality it is not. All practitioners from doctors to physiotherapists to alternative therapists should know the red flags and ask the red flag questions in their examinations. They should also be aware of how to refer patients on when necessary. Serious conditions may not be obvious in any examination at times but having a checklist of red flags is vital, as going logically through a list limits the likelihood of skipping questions and missing important matters.

Loss of weight: If someone has lost a lot of weight in a short time then the reason for this should be explored as there may be many valid explanations for this. Being on a diet can explain this, or the unwillingness to eat of people who are very depressed, upset or anxious. Heavy workers who suddenly have to stop work can also lose significant muscle mass. Red flags should be reported as positive if no defined reason for the weight loss can be found.

Loss of appetite/eating poorly: If the person does not want to eat or has lost their appetite recently, the remarks about weight loss above apply.

Feeling unwell: If you ask people with chronic pain problems if they feel well in themselves they often answer yes. Anyone who complains of persistently feeling unwell, especially with loss of appetite and weight loss, should be regarded with suspicion.

Pain at Night: Back pain and many other conditions are painful during the nights but any pain which is worse at night or on lying down should be regarded with suspicion and recorded as a potential red flag.

Morning stiffness: Musculoskeletal conditions are often stiff in the morning after a night without much movement of the joints. However, if the stiffness is severe and lasts for more than an hour or most of the day if could indicate an arthritic disease.

Previous History of Cancer: Any previous problems with cancer should be enquired about as the condition might recur and explain the presenting symptoms.

Control of Bladder and Bowel: Incontinence can be caused by many conditions from having had children to irritable bowel syndrome to neurological conditions. However, any new incidence of incontinence or retention (difficulty passing urine) should be flagged up for medical review.

Saddle anesthesia: The saddle is the perineal area, the skin around the genitals and anus. An alteration or loss of feeling in this area, for instance when drying oneself with a towel, could be the indicator of a serious problem.

Increased Tone: This can be apparent on walking but is more often noticed by testing the limbs to assess any increased muscle tone. Clonus, increased reflexes and heightened tone point towards a problem with the central nervous system.

Muscle Weakness. Weakness may occur due to damage to a joint or muscle or due to one of the spinal nerve roots being affected. A condition which gives widespread weakness or weakness in more than one nerve root should be flagged as suspicious.

The Age of the Patient: Between twenty and fifty-five years of age is the typical age range for most musculoskeletal conditions to present initially. If a patient is seen with the onset of their condition in younger or older life there is an increased risk of a medical condition to explain their symptoms.

Importance of the Patient's Age: Typically, painful conditions such as low back or neck pain come on in adult life between 20 and 55 years old. Anyone whose pain problem arises when they are much younger or much older has a higher risk of an underlying medical problem.

Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Edinburgh or elsewhere in the UK.

Added: March 2, 2009
Source: http://ezinearticles.com/