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History. Red Flags for LBP. Name the R ed F lags for LBP?. Red Flags to LBP. Cancer Related Red Flags with Low Back Pain Infection Related Red Flags with Low Back Pain Cauda Equina Syndrome Related Red Flags with Back Pain Significant Herniated nucleus pulposus

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red flags to lbp
Red Flags to LBP
  • Cancer Related Red Flags with Low Back Pain
  • Infection Related Red Flags with Low Back Pain
  • CaudaEquina Syndrome Related Red Flags with Back Pain
  • Significant Herniated nucleus pulposus
  • Vertebral Fracture related red flags with Low Back Pain
  • Abdominal Aortic Aneurysm red flags with Low Back Pain
red flags cancer related red flags with low back pain
Red Flags: Cancer Related Red Flags with Low Back Pain
  • A. History of cancer
  • B. Unexplained weight loss >10 kg within 6 months
  • C. Age over 50 years or under 17 years old
  • D. Failure to improve with therapy
  • E. Pain persists for more than 4 to 6 weeks
  • F. Night pain or pain at rest
  • D. Immunocompromised states
    • 1.Systemic Corticosteroids
    • 2.Organ transplant
    • 3.Diabetes Mellitus
    • 4.Human Immunodeficiency Virus (HIV)
    • 5.Rest Pain
red flags infection related red flags with low back pain
Red Flags: Infection Related Red Flags with Low Back Pain
  • A. Persistent fever (temperature over 100.4 F)
  • B. History of intravenous Drug Abuse
  • C. Recent bacterial infection
    • 1.Urinary Tract Infection or Pyelonephritis
    • 2.Cellulitis
    • 3.Pneumonia
red flags cauda equina syndrome related red flags with back pain
Red Flags: CaudaEquina Syndrome Related Red Flags with Back Pain
  • A. Urinary Incontinence or retention
  • B. Saddle anesthesia
  • C. Anal sphincter tone decreased or fecal Incontinence
  • D. Bilateral lower extremity weakness or numbness
  • E. Progressive neurologic deficit
red flags significant herniated nucleus pulposus
Red Flags: Significant Herniated nucleus pulposus
  • A. Major Muscle Weakness (strength 3 of 5 or less)
  • B. Foot drop
red flags vertebral fracture related red flags with low back pain
Red Flags: Vertebral Fracture related red flags with Low Back Pain
  • A. Prolonged use of Corticosteroids
  • B. Mild trauma over age 50 years
  • C. Age greater than 70 years
  • D. History of Osteoporosis
  • E. Recent significant trauma at any age
    • 1.Ejection from motor vehicle
    • 2.Fall from substantial height
red flags abdominal aortic aneurysm red flags with low back pain
Red Flags: Abdominal Aortic Aneurysm red flags with Low Back Pain
  • A. Abdominal pulsating mass
  • B. Atherosclerotic vascular disease
  • C. Pain at rest or nocturnal pain
  • D. Age greater than 60 years
references
References
  • VIII.ReferencesA.Atlas (2001) J Gen Intern Med 16:123
  • B.Petri(1999) Emerg Med Clin North Am 17:25-39
  • C.Swenson(1999) NeurolClin 17:43-63
study on red flags
Study on Red Flags
  • Overall, 11 of 1172 (0.9%) patients were confirmed as having a serious spinal condition, including spinal fracture (n = 8), caudaequina syndrome (n = 1), or inflammatory disorder (n = 2).
  • No patients were identified with cancer or infection as the cause of their pain.
  • For spinal fractures, the diagnostic accuracy of the following red-flag questions was determined: (1) age > 70 years, (2) significant trauma, (3) prolonged corticosteroid use (duration not defined), and (4) altered sensory level (from the trunk down).
temperature
Temperature
  • Viscosity
  • NCV – increase with heat
  • Blood flow – heat increases
  • Collagen extensibility – heat increases tendon and collagenase activity is increased
heat uses are
Heat uses are
  • hyperemia
  • analgesia
  • hyperthermia
  • decrease muscle tone
  • increase in collagen elasticity
heat therapy
Heat Therapy
  • Chronic
  • Proximal
  • Reduce muscle spasms
  • Pain reduction
  • Reduce stiffness and contractures
  • Arthritis
  • Chronic inflammation
contraindications to heat
Contraindications to Heat
  • Ischemia (10% increase in skin temp there is 100% increase in metabolic demand)
  • Bleeding disorders
  • Impaired senation
  • Inability to communicate or respond to pain
  • Malignancy
  • Acute trauma or inflammation
  • Scar formation