Cancer (14)
- subacute presentation
- insidious onset
- constant unremitting pain
- non-mechanical
- no relief with rest
- night pain
- unexplained weight loss
- unwell
- associated systemic symptoms
- past hx of Ca
- family hx of Ca
- Age > 50 yrs with first onset
- Cancer risk factors
- worsening trajectory
Infection risk (14)
- acute and subacute presentations
- recent open wound
- post-surgery or invasive procedure
- in-dwelling catheter or another in-dwelling device
- UTI or other recent infection
- Immunosuppressed
- HIV positive
- IV drug use
- Poor social environment
- Fevers
- Rigors
- Night sweats
- Unwell
- Hot locally
Inflammatory risk (23)
- persistent episodic pain
- slow insidious onset
- AM stiffness > 1/2 hr
- AM worst time
- Wake second half of night; better when get up
- Eased with activity
- Worse with rest
- NSAIDs help++
- Hot bath/shower helps++
- Multi joint involvement
- Hot/red/swollen peripheral joints
- Family hx
- Eye redness
- Psoriasis
- Dry eyes/mouth
- Infection as trigger
- Stomach problems related to joint pain
- Enthesopathies
- Alternating SIJ pain
- Dactilitis
- Persistent limitation all directions
- Hip/shoulder/neck stiffness am
- Fatigue/fever/malaise
Fracture risk (8)
- Post trauma
- Immediate onset pain
- Central deep pain
- High severity (usually)
- Multi-directional provocation
- Osteoporosis/risk
- > 50 or >75+
- female
- long term steroid use
- metabolic disease
- low BMI
- other non-traumatic #
- Acute spinal deformity
- Bony tenderness
Canadian cervical spine rules for imaging
High risk factors:
- over 65 yrs
- dangerous MOI
- sensory deficit in extremities
OR
Low risk factor + unable to rotate L + R 45 deg
Upper cervical instability risk (17)
- can be both acute or ongoing
- post UCS trauma or unguarded movement
- Post-surgery in the area
- RA, Downs, Ehlers-Danlos
- Complain of recurring wry necks
- Feels the need to support the head
- Feeling of instability
- Clunk with movements
- Lump in throat - worse with movement
- Lip paraesthesia
- Hemi tongue numbness
- Metallic taste
- Nausea
- Occipital Numbness
- Tinnitus
- Cord signs (cervical myelopathy)
- Sometimes VBI signs
Cardiac Risk (15)
- can be acute - heart attack
- or ongoing - angina
- Agg by physical activity
- Eased with rest
- Chest pain discomfort and tightness
- Pain/discomfort/heaviness in arm
- Associated jaw pain
- Associated shoulder, neck, back pain
- Choking or burning feeling in throat
- Shortness of breath
- Cold sweat with symptoms
- Nausea
- Feeling unwell
- Light headed
- Dizziness
Neurological risk - Shingles (2)
Severe non-mechanical pain
Dermatomal distribution - rash develops in the dermatome also
This can involve the head
Neurological risk - Cervical myelopathy (9)
- Chronic presentations mainly
- Old age
- Previous radiculopathy?
- Bilateral limb symptoms
- Sock parasthesia/anaesthesia
- Unsteadiness
- Falls and tripping
- Clumsiness
- Hyperreflexia
Cervical arterial dissection (CAD) (20)
- Very acute onset
- Generally in younger population
- Risk factors for CVD
- Hx of migraine
- Contraceptive pill
- Recent neck trauma (inc. manipulation)
- Recent infection (coughing vomiting)
- Acute onset unfamiliar neck/head pain
- Severe pain
- Feels unwell
- Recent unfamiliar neurological symptoms
- 5Ds and 3Ns
- Other visual problems
- Hearing problems
- Balance problems
- Gait problems
- Drooping eye lid
- Constricted pupil
- Cranial nerve dysfunction
- Hypertension
Vertebrobasiliar insufficiency (VBI) [5Ds 3Ns & risk factors]
persistent episodic symptoms
> 65 yrs
poor cardiovascular health
risk factors for CV disease
Following symptoms with sustained neck positions:
5 Ds
- Dizziness and/or unsteadiness
- Diplopia
- Dysarthria
- Dysphasia
- Drop attacks (sudden collapse)
3 Ns
- Nystagmus (spontaneous)
- Nausea/vomiting
- Numbness or paraesthesia (around the mouth/nose)
Temporal Ateritis (9)
- Older age
- Temporal pain
- Thickened Temporal artery
- Visual disturbances
- Jaw claudication
- Tongue pain
- Sensitive scalp
- Tinnitus
- Dx of polymyalgia rheumatica
