The document provides information on medical red flags and common red flags associated with various body regions. It defines red flags as signs or symptoms that may warrant referral to another provider. The document then summarizes several studies on red flag documentation and lists many common red flags for various areas including back, chest/ribs, shoulder, sacrum/pelvis, lower quadrant, and leg. Red flags listed indicate potential serious conditions needing referral such as cancer, infection, fractures, or cardiovascular issues.
1. The document provides information about stroke, including its definition, risk factors, pathophysiology, early warning signs, and primary impairments. It notes that stroke is caused by either blockage or rupture of blood vessels in the brain.
2. High blood pressure, diabetes, heart disease, smoking, age, race, family history, and prior stroke or TIA are identified as major risk factors. Ischemic and hemorrhagic strokes are described in terms of pathophysiology.
3. Early warning signs include sudden numbness, confusion, vision problems, and difficulty walking or balancing. Primary impairments involve sensation, motor function, coordination, reflexes, and speech/language.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...OluwadamilareAkinwan
This document presents an overview of physiotherapy management for chronic obstructive pulmonary disease (COPD). It discusses the epidemiology, pathophysiology, clinical features, diagnosis, stages, and medical management of COPD. It then describes the role of physiotherapy during acute exacerbations, including techniques to reduce work of breathing and secretion removal. Physiotherapy is also involved in pulmonary rehabilitation to improve patient function and management through exercise training and education. Physiotherapy aims to prevent exacerbations and optimize lung function in stable COPD patients.
This document discusses the anatomy, biomechanics, causes, symptoms, diagnosis, and treatment of rotator cuff tears. It begins by introducing the rotator cuff muscles and their function in stabilizing the shoulder joint. Common causes of tears include impingement, trauma, aging, and ischemia. Symptoms include shoulder pain that is worsened with overhead activities. Diagnosis involves physical exam maneuvers like the Neer's and Hawkins tests as well as imaging like x-rays, ultrasound, CT, or MRI. Treatment ranges from rest, physical therapy, and injections for mild cases to surgical repair for larger or chronic tears if conservative measures fail.
SPONDYLOLISTHESIS: DIAGNOSIS, CLASSIFICATION, EVALUATION AND MANAGEMENTBenthungo Tungoe
Spondylolisthesis is the forward slippage of one vertebra on another. There are several classifications including developmental, isthmic, degenerative, traumatic, and postsurgical types. Developmental spondylolisthesis is usually asymptomatic and rarely progresses after adulthood. Isthmic spondylolisthesis has a risk of progression over 25% slippage or in symptomatic cases. Degenerative spondylolisthesis results from sagittal facet orientation or disc degeneration and increases in older females. The natural history depends on factors like age, gender, slip severity and progression.
The document discusses the examination of cervical disorders. It begins with an introduction to the anatomy of the cervical spine and then describes the various functions of the spine. The document outlines the process for examining the cervical spine, including obtaining a history, inspecting for abnormalities, palpating the spine, and performing special tests to assess range of motion and potential nerve impingement. Common cervical conditions like herniated discs and bone spurs are also summarized. The examination techniques are explained in detail with diagrams to illustrate proper procedures like compression, distraction, and rotation tests.
This document provides guidance on rehabilitation for non-operative and operative back pain. It discusses assessing abnormalities and treating to correct them. For severe back pain, it recommends reducing pain and inflammation through comfort positions, movement, medications, modalities, and exercise away from aggravation. For sub-acute back pain, it recommends manual therapy, restoring range of motion and flexibility/strength training. Post-episode, it recommends modifying activities, correcting biomechanical abnormalities, and implementing a home exercise regime. Core stability and stabilization exercises are emphasized for retraining deep muscles to maintain functional stability. Post-operative rehabilitation focuses on early mobility, exercises in neutral spine, and functional control prior to discharge with a home program.
The document discusses cerebellar ataxia, a disorder caused by damage to the cerebellum that controls coordination. It causes loss of coordination, balance problems, and slurred speech. The cerebellum coordinates muscle movement and is located in the hindbrain. Causes include viruses, alcohol, tumors, and toxins. Symptoms are diagnosed through neurological exams, imaging scans, and lab tests. Treatment focuses on physical therapy, assistive devices, and treating any underlying causes to ease symptoms and improve quality of life. Prevention involves vaccinations to reduce risk of viral infections that can lead to cerebellar ataxia.
Peripheral neuropathy refers to damage to peripheral nerves. There are three main types: mononeuropathy affecting a single nerve, mononeuritis multiplex affecting multiple nerves asymmetrically, and polyneuropathy affecting multiple nerves concurrently and symmetrically. Polyneuropathy can be classified as axonopathy, myelinopathy, or neuronopathy depending on whether the axons, myelin sheaths, or neurons are affected. Symptoms and signs include both negative symptoms like numbness and weakness as well as positive symptoms like tingling and pain. Evaluation involves taking a history and examining for patterns of onset, progression, fluctuations, and other systemic diseases. Diagnosis involves nerve conduction studies and sometimes nerve biopsies. Treatment focuses
This document provides information on diagnostic investigations and assessments for cerebellar ataxia. It lists various tests that can be done as part of the diagnostic workup including blood tests, imaging studies, genetic testing, and neurological exams. Specific tests are described to evaluate factors like balance, coordination, gait, dysmetria, and oculomotor performance that may be impaired with cerebellar ataxia. A thorough patient history and neurological exam incorporating several assessment scales are important for evaluating ataxia.
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
Strength is the amount of force a muscle can exert against an external load, while power combines strength and speed of movement. Power is assessed manually through tests of muscle function and strength or instrumentally using devices like dynamometers. Manual muscle testing grades strength on a scale from 0 to 5 based on the ability to overcome gravity and resist pressure. Various instruments can also objectively measure strength of individual muscles or muscle groups. One-repetition maximum testing determines the maximum weight that can be lifted for a single repetition to assess overall muscular strength.
This document discusses shoulder impingement syndrome, including its anatomy, causes, symptoms, diagnosis, stages, and treatment approaches. It provides details on the rotator cuff muscles, signs and symptoms of impingement, external and internal factors that can lead to impingement, stages of the syndrome, common tests used for diagnosis, goals of treatment, and manual therapy, therapeutic exercise, and preventative measures used in treatment.
This document discusses the physiotherapy management of lower limb deformities resulting from polio. It covers strengthening weakened muscles, stretching shortened muscles, use of orthotics and splints, gait training, surgical correction of deformities if conservative treatment is not effective, and physiotherapy after surgeries like tendon transfers. Specific deformities around the hip, knee and ankle are described along with their causes and management approaches. Surgical options discussed include soft tissue releases, osteotomies, arthrodesis and tendon transfers. The overall goal of treatment is to improve strength, prevent deformities, achieve functional mobility and independence.
Parkinson's disease is a chronic, progressive neurological disorder characterized by rigidity, bradykinesia, tremor, and postural instability. It is caused by the loss of dopamine-producing neurons in the substantia nigra. Symptoms worsen over time and can include impaired motor skills and coordination, speech and swallowing difficulties, sensory changes, and cognitive impairment. Physiotherapy aims to improve mobility, balance, and function through exercises targeting flexibility, strength, posture, gait, and functional skills.
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Motor neuron diseases are a group of rare neurodegenerative disorders that progressively cause nerves in the brain and spinal cord to lose function, affecting voluntary muscle movement. The most common type in adults is amyotrophic lateral sclerosis (ALS), which affects both upper and lower motor neurons. There is no cure for motor neuron diseases, so treatment focuses on managing symptoms and maximizing quality of life through supportive care, rehabilitation, and FDA-approved drugs that may slow progression. Prognosis depends on the specific type of motor neuron disease and age of onset, with some forms being fatal and others non-fatal but still impacting quality of life over time.
The Red Flags Rule requires businesses to implement an Identity Theft Prevention Program to detect warning signs ("red flags") of identity theft. The program involves identifying red flags, detecting them, preventing identity theft if detected, and updating the program. Non-compliance can result in fines and civil claims. The company ID Sure provides an Identity Theft Prevention Program template and identity verification services to help businesses comply with the Red Flags Rule deadline of August 1st, 2009.
The document discusses an unaccredited medical education activity produced by Haymarket Medical with guidance from expert faculty. It provides a recommended learning credit value in line with UK recommendations to help participants. The activity was completed by Tracy Culkin on 09/07/2013 and awarded 0.50 learning credits for the program on blurred vision symptoms.
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of type 2 DM. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
The document discusses medical identity theft, the Red Flags Rule requiring healthcare organizations to implement identity theft prevention programs, and challenges related to mitigating medical identity theft. Key points include the May 1, 2009 deadline for compliance with the Red Flags Rule; impacts of medical identity theft such as incorrect medical records leading to denied insurance or unsafe treatment; and recommendations for individuals and healthcare providers to prevent medical identity theft such as verifying patient identification and securing private health information.
This document discusses various eye disorders including astigmatism, cataracts, and their symptoms, diagnosis, and treatment. Astigmatism is a refractive error of the eye that can cause blurred vision and results from genetic or environmental factors. Cataracts are a clouding of the eye's lens that causes blurred or faded vision and are related to aging, diabetes, or other health conditions. Treatment for both involves glasses, contact lenses, or surgery depending on severity. Regular eye exams are important for detection and prevention of vision problems.
1. The patient is a 62-year-old male who presented with blurred vision and headaches for one month. Examination found mild cataracts and tessellated fundi in both eyes.
2. Imaging found an enlarged pituitary fossa with bony changes and soft tissue, suggestive of a pituitary tumor.
3. Laboratory tests found slightly elevated prolactin and slightly decreased TSH, consistent with a possible prolactinoma or non-functioning pituitary adenoma.
4. The differential diagnosis includes pituitary adenoma, meningioma, craniopharyngioma, or other etiologies. Follow-up with visual field testing and MRI is planned.
This document provides information on common disorders and conditions of the eye. It begins with an overview of eye anatomy including the three layers of the eyeball. It then discusses various refractive errors like hyperopia, myopia and astigmatism. Next it covers muscular disorders such as nystagmus and strabismus. Disorders of the eyelid including hordeolum, chalazion and blepharitis are described. Finally it examines disorders of the globe of the eye including keratitis, cataracts, glaucoma, macular degeneration and more. Treatment options are provided for each condition.
This document discusses various medical treatments for glaucoma, including topical eye drop medications from different drug classes. It describes the mechanisms of action, administration, efficacy and side effects of prostaglandin analogues, beta blockers, carbonic anhydrase inhibitors, alpha-2 agonists, miotics, osmotic agents, and some combination drug preparations. The document provides detailed information on commonly used glaucoma drugs to help clinicians select appropriate treatment options based on a patient's needs and risk factors.
The document discusses various medical treatments for glaucoma, including different drug classes and their mechanisms of action, indications, contraindications and side effects. It provides detailed information on adrenergic agonists, beta-adrenergic antagonists, carbonic anhydrase inhibitors, and combined medications used to treat glaucoma. Key points covered include how the drugs work to lower intraocular pressure, when they should and should not be used, and common adverse effects.
The document discusses common eye diseases and how to prevent them. It outlines major eye conditions like cataract, glaucoma, and conjunctivitis that are increasing due to pollution and poor diets. It recommends getting regular eye exams to detect diseases early and protecting eyes with sunglasses and proper contact lens care. Maintaining a diet with vitamins A and C and checking children's eyes regularly is important since their eyes are still developing.
The document provides information on abdominal pain and gastrointestinal symptoms. It describes various types of abdominal pain including visceral, parietal, and referred pain. It lists common symptoms associated with gastrointestinal disorders like abdominal pain, dysphagia, heartburn, vomiting, and changes in bowel habits. The document then discusses patterns of referred pain and sites of abdominal pain according to embryological origins. It provides details on character of pain from different conditions and lists common causes of abdominal pain in different age groups and gender.
This document discusses the assessment of the cervical spine. It outlines the muscles of the cervical spine including posterior, lateral, and anterior muscles. It describes common signs and symptoms of cervical spine issues like pain, stiffness, numbness, and headaches. Red flags indicating more serious pathology are mentioned. The assessment involves taking a patient history, performing an examination of ranges of motion, reflexes, dermatomes, and special tests. Differential diagnoses that may be considered are also listed.
This document provides an overview of low back pain (LBP), including prevalence, classifications, types, and key points regarding evaluation and management. Some key points:
- 60-80% of people experience LBP at some point, though 90% resolves within 6 weeks. Recurrence is common and LBP is a major cause of disability.
- LBP can be classified as mechanical, traumatic, infectious, neoplastic, and more. 97% are considered mechanical.
- Types include discogenic, radicular, facet joint, sacroiliac joint, muscular/myofascial, and others. Herniated discs can cause radicular symptoms.
- Evaluation involves detailed history and exam to identify
This document provides information on various types of chest pain and their characteristics. It discusses:
- The location, duration, precipitating/relieving factors, and associated symptoms of angina, myocardial infarction, pericarditis, pulmonary embolism, gastrointestinal issues like peptic ulcer disease, and other potential causes.
- Descriptions of arrhythmias like premature ventricular contractions and their symptoms. Causes and presentations of cardiac arrest are also outlined.
- Details on performing a physical exam for signs of heart failure like edema, jugular vein distension, and orthopnea. Assessment of vital signs including orthostatic blood pressure changes is described.
This document discusses several cardiovascular disorders related to disturbances in oxygen transport, including structural heart valve disorders like mitral valve prolapse, mitral regurgitation, and mitral stenosis. It also covers infective endocarditis, rheumatic heart disease, myocarditis, pericarditis, aortic aneurysm, and vascular disorders like Buerger's disease, Raynaud's disease, and venous thrombosis. For each condition, it provides information on clinical manifestations, diagnosis, and treatment approaches.
Evaluation of acute abdominal pain in the emergency department can be challenging as there are many possible diagnoses ranging from life-threatening to self-limiting conditions. A thorough history and physical exam is important to identify "red flags" that suggest serious underlying causes of pain such as sudden onset, maximal intensity pain or migration of pain. The physical exam focuses on vital signs, inspection of the abdomen, auscultation, percussion and gentle palpation to help localize the source of pain and identify signs of peritoneal irritation. Recognition of surgical or life-threatening causes is prioritized over establishing a firm diagnosis.
This document discusses non-traumatic abdominal pain in children. It begins by noting the variation in how children perceive and tolerate abdominal pain. It then describes the two types of nerve fibers that transmit painful stimuli in the abdomen - A fibers which mediate sharp localized pain and C fibers which transmit poorly localized, dull pain. It explains how somatic pain tends to be intense and well-localized while visceral pain is dull, aching and experienced in the dermatome of the affected organ. Referred pain from other areas like the lungs can also cause abdominal pain. Certain characteristics of the pain can provide clues to diagnosis.
Abdominal pain in pregnancy can have many potential causes including obstetric, gynecological, surgical, and medical issues. A thorough history and physical exam is important to determine the cause, which may include conditions like preterm labor, placental abruption, appendicitis, or ectopic pregnancy. Based on the findings, appropriate investigations like urine tests, ultrasound, and fetal monitoring can help make the diagnosis. Management is tailored to the specific cause but the priority is always the health and safety of the mother and baby.
Case 1 involves a 40-year-old male who presented with severe lower back pain after heavy lifting with no pain radiation. Examination found reduced forward flexion, tender L5 and muscles, and no neurological symptoms.
Case 2 involves a 35-year-old male with similar presentation but pain radiating down his left leg to the ankle. Examination found weak left ankle plantar flexion and big toe flexion with altered sensation over the left foot lateral side.
Abdominal pain is pain that occurs between the chest and pelvic region. Abdominal pain can be crampy, achy, dull, intermittent or sharp. It 's also called a stomachache. Inflammation or diseases that affect the organs in the abdomen can cause abdominal pain.
History and examination of acute abdomen by dr fahad akhtarFahad Akhtar
This document provides an overview of acute abdomen including definitions, common causes, history taking, and physical examination. Key points include: acute abdomen is defined as severe abdominal pain requiring urgent surgery; common surgical causes include appendicitis, cholecystitis, and perforated ulcers; a thorough history focuses on pain characteristics and associated symptoms; physical exam involves inspection, auscultation, percussion, and localized palpation to identify areas of tenderness. Specific examination findings can suggest etiologies like appendicitis, pelvic inflammation, or hemorrhage.
A 28-year-old female presented with 4 days of abdominal pain that started around the umbilical area and shifted to the right lower quadrant, accompanied by fever and diarrhea. On examination, she had tenderness and rebound tenderness in the right lower quadrant, along with other signs positive for appendicitis. Laboratory tests showed elevated white blood cell count with neutrophilia. Based on her history, presentation and test results, she was diagnosed with acute appendicitis.
This document discusses the evaluation and differential diagnosis of abdominal pain. It notes that history and physical examination are important for diagnosis as subtle symptoms can indicate serious conditions. The document outlines key components of a patient's history and details the examination. It describes various causes of abdominal pain classified by location, mechanism, and onset. Radiological investigations that may assist diagnosis are also summarized. The document stresses that the severity of pain does not always correlate with the severity of the underlying condition.
The document provides information on acute abdomen including its definition, epidemiology, physiology, differential diagnosis by location, history and physical examination findings, important investigations, management principles, and criteria for surgical consultation. Acute abdomen is defined as sudden severe abdominal pain lasting less than 24 hours that often requires urgent diagnosis and some causes need surgical treatment. The differential diagnosis considers location of pain and includes conditions like appendicitis, diverticulitis, bowel obstruction, pancreatitis and others. Key aspects of evaluation involve history, physical exam, labs, imaging and identifying high-risk patients who may require emergent surgery.
Chest pain can be cardiac or non-cardiac in origin. Cardiac causes include angina, myocardial infarction, and pericarditis while non-cardiac causes include pulmonary embolism, pneumonia, gallbladder disease, and musculoskeletal disorders. Characteristics of ischemic cardiac chest pain include central location, radiation to the jaw/arm, tight or squeezing quality, and precipitation by exertion. Differential diagnosis of chest pain involves evaluating for life-threatening causes, chronic serious conditions, treatable acute conditions, and other chronic treatable conditions. Distinguishing ischemic cardiac chest pain from non-cardiac pain relies on characteristics such as location, quality, precipitating/relieving factors, and associated symptoms.
Chest pain can be cardiac or non-cardiac in origin. Cardiac causes include angina, myocardial infarction, and pericarditis while non-cardiac causes include pulmonary embolism, pneumonia, gallbladder disease, and musculoskeletal disorders. Characteristics of ischemic cardiac chest pain include a central, pressing or squeezing quality that radiates to the jaw/arm and is provoked by exertion. Differential diagnosis of chest pain requires evaluating characteristics like location, quality, duration and associated features to determine cardiac vs. non-cardiac etiology.
Approach to the patient with Low Back Pain.pptxdoctetoo
Low back pain is very common, affecting up to 84% of adults at some point in their lives. Most cases are mechanical low back pain such as lumbar strain or sprain, and can be effectively managed in primary care. A thorough history, physical exam, and screening for red flags can identify underlying conditions that may require imaging or specialist referral. Treatment focuses on pain relief, improving function, and patient education on prevention. Referral is indicated for red flag symptoms or if pain persists after 6 weeks of conservative treatment.
Chest pain can be cardiac or non-cardiac in origin. Cardiac causes include myocardial ischemia, angina, and acute coronary syndromes which present with characteristic dull, squeezing pain in the center of the chest that may radiate to the arms and is exacerbated by exertion. Non-cardiac causes include pulmonary embolism, pneumonia, gallbladder disease and musculoskeletal disorders which typically cause localized, sharp pains. A thorough history and physical exam is needed to differentiate cardiac from non-cardiac chest pain and determine appropriate treatment or need for further testing.
This document outlines the components and purpose of a scanning examination performed in physical therapy. The scanning exam is used to ensure issues are within the scope of physical therapy and rule out serious pathology. It involves observation of gait and posture, vital signs, functional movement testing, tissue tension testing, palpation, neurological exams, and special tests. The purpose is to detect gross loss of function and movement control in order to guide further physical therapy diagnosis and treatment.
A lecture about Technology in Physical Therapy Practice. Given at the OPTA Western District Meeting on 06/30/11 by Casey Kirkes PT, DPT and Dale Boren Jr. PT, MPT, O
This new employee orientation covers the following key points in 3 sentences:
The orientation reviews PTC's core values, the employee's role and responsibilities, professional development training, who the various company partners are, documentation and billing standards, and emphasizes having fun while embracing change. Employees will complete personality and learning assessments, learn about mentoring resources, and get an overview of performance reviews, social media guidelines, and the importance of teamwork and excellent customer service. The goal is to onboard new employees effectively and get them started on a path of continued learning and professional growth as part of the PTC team.
This document summarizes research on the treatment of femoroacetabular impingement (FAI) with manual therapy. It discusses the anatomy and causes of FAI, as well as diagnosis using imaging and clinical exams. While evidence directly comparing manual therapy to exercise for FAI is limited, manual therapy techniques used successfully for hip osteoarthritis may also benefit FAI by increasing range of motion and reducing pain. Case reports show positive outcomes with manual therapy including traction, mobilization, and soft tissue techniques for FAI patients. More research is still needed on rehabilitation approaches for FAI.
This document provides information about fibromyalgia including its definition, symptoms, diagnosis, treatment, and prognosis. Fibromyalgia is defined as a chronic pain condition characterized by widespread muscle aches, pain and tenderness in at least 11 of 18 tender points. It predominantly affects women and has no known cause but may involve abnormalities in how the brain processes pain signals. Treatment involves lifestyle modifications like exercise, stress management and adequate sleep, along with medications to reduce pain and improve symptoms. While there is no cure for fibromyalgia, treatment can help manage symptoms and many people are able to lead active lives.
The document provides information on performing a differential diagnosis examination for the hip. It discusses evaluating the hip for common conditions like osteoarthritis, fractures, bursitis, labral tears, and referred pain from the low back. Physical examination tests are outlined to help determine the likely cause of hip pain, including assessing range of motion, special tests, and risk factors. The goal is to systematically examine the hip to form an evidence-based diagnosis and guide appropriate treatment.
This document provides an overview of a physical therapy course on total hip rehabilitation. The course objectives are to understand hip surgery and exercises, describe hip biomechanics, and effectively progress patients through rehabilitation. The schedule covers topics like evidence-based practice, anatomy, exercises, and outcome measures. Recent advances in hip rehabilitation include smaller incisions, reduced hospital stays, and early mobilization leading to better short-term outcomes. Assessment tools for hip function include the Lower Extremity Function Scale and Harris Hip Score.
This document provides a reading list and brief summaries of books recommended by Physical Therapy Central, Inc. It recommends several business and self-help books, including Michael Levine's "Broken Windows", which is described as a short, easy read; Tom Rath's "StrengthFinder 2.0", which helped change the author's thinking; and Jim Collins' "Good to Great", which helped focus the author and change how they run their business. It also lists books by Eckhart Tolle, Malcolm Gladwell, Michael Gerber, and others and provides short blurbs about each.
This document provides a reading list and brief summaries of books recommended by Physical Therapy Central, Inc. It recommends several business and self-help books, including Michael Levine's "Broken Windows", which is described as a short, easy read; Tom Rath's "StrengthFinder 2.0", which helped change the author's thinking; and Jim Collins' "Good to Great", which helped focus the author and change how they run their business. It also lists books by Eckhart Tolle, Malcolm Gladwell, Michael Gerber, and others and provides short blurbs about each.
1. Medical RED FLAGS
Recognition and Referral
By Shawn Houck
April 25, 2010
2. What are RED FLAGS?
Definition:
1) “signs and symptoms of certain conditions that may warrant referral to another
health care provider” (Flynn et al. 2008)
2) “any potential signs and symptom that would indicate the problem is not a
musculoskeletal one or a more serious problem that should be referred to the
appropriate health care professional.” (Magee 2007)
Why do we screen for RED FLAGS?
-For the patients
-For the future of our profession (autonomous practice)
Leerar et al. (2007). “Documentation of Red Flags by Physical Therapists For Patients with Low Back
Pain”. Journal of Manual & Manipulative Therapy, 15(1), 42-49.
One-hundred and sixty clinic charts from 6 different outpatient PT clinics were collected and
analyzed for overall red flag documentation for patients with low back pain. After data collection, the
results indicated that seven of the 11 red flag items were documented over 98% of the time. “Regularly
documented” items included age over 50, bladder dysfunction, hx of cancer, immune suppression, night
pain, hx of trauma, saddle anesthesia, and lower extremity neurological deficit. Red flags that were “not
regularly documented” included weight loss, recent infection, and fever/chills. Authors concluded that
PTs should verbally verify with the patient during the evaluation any possible red flags (since pts may
not thoroughly understand how conditions can be linked). Also, more comprehensive patient self-
report questionnaires should be used to accurately identify red flag items.
3. HEAD, NECK, AND BACK
Common RED FLAGS for Back Pain (Goodman & Synder 2007)
• Age less than 20 or over 50
• Previous hx of cancer
• Fever, chills (infection)
• Unexplained weight loss
• Recent urinary tract infection
• Night pain not relieved by rest and/or worse with recumbency (cancer)
• Progressive, neurologic deficit (e.g. saddle anesthesia)
• Abdominal pain radiating to midback; sx associated with food, worse after NSAIDs (pancreatitis, GI
disease, peptic ulcer)
• Significant morning stiffness with limitation in all spinal mvmts (ankylosing spondylitis or other
inflammatory disorder)
• Skin rash (inflammatory disorder, e.g. Crohn’s disease, ankylosing spondylitis)
• Back pain relieved by sitting up and leaning forward (pancreas)
• Back pain in athletic teenager (epiphysitis, juvenile discogenic disease,
spondylolysis/spondylolisthesis)
• Sudden, localized back pain that does not diminish by 2 weeks in postmenopausal or osteoporotic
women (compression fracture)
Cauda Equina Syndrome
• Low back pain • Changes in bowel/bladder function
• Unilateral or bilateral sciatica • LE motor weakness/sensory deficits
• Saddle anesthesia or perineal • Diminished or absent LE DTR’s
hypoesthesia
Oncologic Spine Pain
• Severe weakness w/o pain • Progressive neurological deficits
• Weakness with full range • Signs/sx associated with visceral
• Sciatica caused by metastases to pelvis, systems
lumbar, or femur • Positive percussive tap test to one or
• Constant pain (does not vary with more spinous process
position/activity • Palpable mass in neck/upper torso with
• Skin temperature differences L/R occipital HA and neck pain
4. Aortic Aneurysm
• Rapid onset of severe neck/back pain • Pain not relieved by change in position
• Pain radiating to chest, shoulders, back • “Tearing” or “ripping” pain
(between scapulae), abdomen, or post. • Cold, pulseless lower extremities
thighs
GI Dysfunction
Anterior neck or back pain accompanied by:
• Esophageal pain • Bloody stool/diarrhea
• Epigastric pain with radiation to the • Fecal incontinence
back • Melena (dark, abnormal stool caused by
• Dysphagia (difficulty swallowing) oxidized blood)
• Odynophagia (pain with swallowing)
Location of Systemic Thoracic/Scapular Pain (Goodman & Synder 2007)
Cardiac
Myocardial infarct Midthoracic spine
Aortic aneurysm Thoracic spine; thoracolumbar spine
Pulmonary
Basilar pneumonia Right upper back
Empyema Scapula
Pleurisy Scapula
Pneumothorax Ipsilateral scapula
Renal
Acute pyelonephritis Costovertebral angle (posteriorly)
Gastrointestinal
Esophagitis Midback between scapulae
Peptic ulcer Sixth through tenth thoracic vertebrae
Gallbladder disease Midback between scapulae; right upper scapulae or subscapular area
Biliary colic Right upper back; midback between scapulae; right interscapular/subscap
Pancreatic carcinoma Midthoracic or lumbar spine
Other
Acromegaly Midthoracic or lumbar spine
Breast cancer Midthoracic spine or upper back
5. CHEST/RIBS
Common RED FLAGS Associated with Chest/Ribs (Goodman & Synder 2007)
• Sudden onset on acute chest pain with difficulty breathing (pulmonary embolism,
myocardial infarction, ruptured abdominal aneurysm)
• Pain occurring without exertion, lasting longer than 10 min, not relieved by
rest/nitroglycerin (unstable anginaheart attack)
• Chest pain relieved by antacid (reflux esophagitis)
• Chest, neck, or shoulder pain aggravated by physical exertion, precipitated by working
with arms overhead (>5 min), light-headedness, profuse perspiration (cardiovascular)
• Chest/rib pain eliminated when lying on involved side, known as “autosplinting”
(pleuropulmonary)
• Persistent cough, dyspnea, and symptoms that increase in the supine position
(abdominal contents push up on diaphragm and against parietal pleura)
(pleuropulmonary)
Myocardial Ischemia
Men Women
• “Squeezing, fullness” pressure/discomfort • Classic chest discomfort
under sternum, mid or entire chest region • Dyspnea (at rest or with exertion)
• Pain may occur in jaw, upper neck, • Weakness and lethargy
midback, or down arm without chest pain • Indigestion or heart burn
• Pain in arm (usually left, sometimes both) • Lower abdominal pain
• Anxiety/depression
is most often along the ulnar nerve
• Sleep disturbances
distribution
• Isolated midthoracic back pain
• Isolated right biceps ache
• Sensation of “inhaling cold air”
6. Gastrointestinal Disorders
• Chest pain that may radiate to the back • Pain on swallowing or associated with
• Symptoms aggravated in meals
supine/relieved in upright position • Jaundice
(upper GI problem) • Heartburn/indigestion
• Nausea, vomiting • Dark urine
• Blood in stools
Anabolic Steroid Use
• Chest pain • Gynecomastia (breast tissue
• Elevated BP development in males) and breast
• Ventricular tachycardia tissue atrophy in females
• Weight gain (10-15 lbs in 2-3 weeks) • Frequent hematoma or bruising
• Peripheral edema • Personality changes “steroid psychosis”
• Acne on face, upper back, chest • Females: development of secondary
• Delayed tissue healing times male characteristics
• Jaundice (chronic)
7. SHOULDER/UPPER
EXTREMITY
Common RED FLAGS Associated with the Shoulder/Upper Extremity (Goodman & Synder
2007)
• Hx of rheumatic disease, recent (1-3 mo) myocardial infarction (chronic regional pain
syndrome), previous cancer especially breast/lung (metastasis), recent
pneumonia/upper respiratory infection/influenza (diaphragmatic pleurisy)
• Hx of diabetes mellitus, hyperthyroidism, ischemic heart disease, infection, and lung
diseases such as tuberculosis, emphysema, chronic bronchitis, Pancoast’s tumors (all are
at risk for adhesive capsulitis)
• Presence of abnormal (hard, fixed) lymph nodes (cancer)
• Shoulder pain in a woman of childbearing age of unknown cause associated with missed
menses (rupture of ectopic pregnancy)
• Left shoulder pain within 24 hours of abdominal surgery, injury, or trauma (Kehr’s sign,
ruptured spleen)
• Shoulder pain relieved by leaning forward, kneeling with hands on floor, sitting upright
(pericarditis)
• Shoulder pain unaffected by position, breathing, or movement (myocardial infarction)
• Shoulder pain accompanied by dyspnea, toothache, belching, nausea, or pressure
behind sternum and relieved by nitroglycerin or antacid drugs (angina)
• Persistent, dry or productive cough, with shoulder pain aggravated in the supine
position (diaphragmatic or pulmonary component)
8. Shoulder/Upper Extremity (cont.)
Location of Shoulder Pain
Systemic origin Left shoulder Systemic Origin Right Shoulder
Lymphatic: Gastrointestinal:
Ruptured spleen L shoulder (Kehr’s) Peptic ulcer Lateral border, R scapula
Cardiovascular: Cardiovascular:
Myocardial ischemia L pectoral/L shoulder Myocardial ischemia R shoulder, down arm
Aortic aneurysm L shoulder Aortic aneurysm R shoulder
Endocrine/GI: Hepatic/Biliary:
Pancreas L shoulder Acute cholecysistitis Between scapulae or
R subscap. area
Pulmonary: Liver abcess R shoulder
Pleurisy Ipsilateral R shoulder, Gallbladder R upper trap, R shoulder
upper trap Liver disease R shoulder, R subscap area
Pneumothorax (same as above) (hepatitis, cirrhosis, tumor)
Pancoast’s tumor (same as above)
Pneumonia (same as above) Pulmonary:
Pleurisy Ipsilateral R shoulder,
Urinary: upper trap
Kidney involvement Ipsilateral shoulder Pneumothorax (same as above)
Pancoast’s tumor (same as above)
Other: Pneumonia (same as above)
Infectious mononucleosis L shoulder/L upper trap
Ectopic pregnancy L shoulder (Kehr’s) Urinary:
Post-op laparoscopy L shoulder (Kehr’s) Kidney involvement Ipsilateral shoulder
9. SACRUM/SACROILIAC AND PELVIS
Common RED FLAGS Associated with Sacroiliac/Sacral Pain or Sx (Goodman & Synder 2007)
• Insidious onset or SI pain without hx of trauma or increased activity levels
• Hx of cancer or GI disease (ulcerative colitis, Crohn’s disease, irritable bowel syndrome)
• Risk factors such as osteoporosis (insufficiency fracture), STDs, long-term use of antibiotics
• Lack of objective findings (negative special tests)
• Anterior pelvic, suprapubic, or low abdominal pain at level of the sacrum
• Pain relieved by passing gas/bowel movement (GI involvement)
• SI radiating around the flank (bladder/urologic dysfunction)
• Presence of other GI, gynecologic, or urologic signs/sx
Common RED FLAGS Associated with Pelvic Pain or Sx
• Hx of reproductive/colon/breast cancer, dysmenorrhea, ovarian cysts, pelvic inflammatory
disease, endometriosis, chronic bladder/UTIs/IBS, previous pelvic or bladder surgeries
• Clinical presentation of
o Poorly localized (diffuse) pain
o Pain aggravated by increased intra-abdominal pressure (e.g. standing, walking,
coughing, intercourse, Valsava maneuver--- GI involvement)
o Pain not affected by specific movements
o Pain that gets at end of day or after prolonged standing (vascular)
o Temporary relief with position change (nerve entrapment, gynecologic dysfunction)
o Pain radiating around flank/genitalia/ant-med thigh (urogenital)
o Positive McBurney’s sign (palpation for appendicitis), Blumberg sign (rebound
tenderness), Positive Iliopsoas/Obturator sign (perforated appendix, inflamed
peritoneum)
o Dyspareunia (pain/difficult intercourse) and/or discharge from vagina/penis
10. LOWER QUADRANT
Common RED FLAGS Associated with the Lower Extremity (Goodman & Synder 2007)
• Hx of cancer, renal/urologic disease, trauma/assault
• Infectious/inflammatory condition (Crohn’s disease, diverticulitis, PID, Reiter’s syndrome,
appendicitis)
• Gynecologic condition (recent pregnancy, multiple births)
• Alcoholism (hip osteonecrosis)
• Long-term use of immunosuppressants (osteonecrosis)
• Heart disease (arterial insufficiency, peripheral vascular disease)
• Hematologic disease (sickle cell anemia, hemophilia)
• Hip or groin pain alternating or occurring simultaneously with abdominal pain at same level
(aneurysm, colorectal cancer)
• Hip pain in young adult that is worse at night and relieved by activity/aspirin (osteoid osteoma)
• Painless neurological deficit(s) (spinal cord lesion)
• Hip/groin pain (insidious onset) in men 18-24 years of age, with any other cancer red flags
(testicular cancer)
Stress Reaction/Stress Fracture in Femur
• Aching/deep aching pain that increases • Pain reproduced by
with activity/improves with rest, translational/rotational stress
possible night pain • Thigh pain (sharp) reproduced by the
• Pain localized to specific area of bone, fulcrum test
reproduced with WB • Increased tone of hip adductors (limited
• Compensatory gluteus medius gait hip abduction)
Buttock, Hip, Groin, or LE Pain Associated with Cancer
• Bone pain (esp. with WB) and localized • Pain relieved disproportionately by
tenderness aspirin
• Antalgic gait • Fever, weight loss, bleeding, skin lesions
• Night pain which is constant/intense • Vaginal/penile discharge
and unrelieved by change in position • Painless, progressive enlargement of
inguinal and/or popliteal lymph nodes
11. Psoas Abscess
(caused by any infectious/inflammatory process in ab/pelvic region)
• Pain confined to psoas fascia, but may • Positive psoas sign (pain with passive
extend to the buttock, hip, groin, upper stretch)
thigh, or knee • Fever, sweats, loss of appetite or other
• Pain located in anterior hip/medial GI symptoms
thigh area (femoral triangle) • Leg resting position of IR
• Psoas spasm (leading to functional hip • Palpable mass in ant. hip or groin (psoas
flexion contracture) abscess, hernia)
Osteonecrosis
• Hip pain (mild at the beginning and • Tenderness to palpation over the hip
progressively worse with time), worse joint
with WB • Hip joint stiffness and problems with
• Possible groin/ant-med. thigh pain dislocation
• Limited hip range of motion (internal • Possible “click” in hip with sit to stand
rotation, flexion, abduction) movements
Hip Hemarthrosis
• Pain in groin/thigh • Limited motion in hip flexion,
• Fullness in hip joint (anterior in groin abduction, and ER (allows for most
and over greater trochanter) room for blood in jt. capsule)
Sickle Cell Anemia
• Athlete slumps to ground • Presence of gross hematuria
• Complaints of general muscle weakness • Severe left upper quadrant pain (splenic
(possible swelling) infarction)
• Mild to moderate pain • May lead to acute exertional
• Palpation=normal muscle tone rhabdomyolysis
• No significant rise in core temperature
12. References
Flynn, T., Cleland, J., & Whitman, J. (2008). The Users’ Guide to the Musculoskeletal Examination:
Fundamentals for the Evidenced-Based Clinician. Evidence in Motion: Louisville, KY.
Goodman, C., & Snyder, T. (2007). Differential Diagnosis for Physical Therapists: Screening for Referral,
4th Ed. Saunders: St. Louis, Missouri.
Leerar et al. (2007). “Documentation of Red Flags by Physical Therapists For Patients with Low Back
Pain”. Journal of Manual & Manipulative Therapy, 15(1), 42-49.
Magee, D (2008). Orthopedic Physical Assessment: Musculoskeletal Rehabilitation Series, 5th Ed.
Elsevier Health Sciences, pg 2.