Red Flags Case Study

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Introduction
Patients with spine pain generally present with a clinical picture that could be created by many different conditions and therefore it is vital that clinicians identify these conditions that may delay a patient’s recovery and function or put them at risk for serious medical consequences. These conditions are known as red flags. Red flags are signs and symptoms that are found in the patient’s history and clinical examination that can link to a serious pathology. They may require further diagnostic assessment and possibly immediate treatment by a specialist. Red flags must be ruled in or out prior to treatment, the likelihood of which can be improved by thorough consideration of patient history, characteristics of the present complaint and physical examination and
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Red Flag Assessment in the Thoracic Spine
Category one findings: Due to the viscerosomatic referred pain, many visceral conditions can produce secondary musculoskeletal pain in thoracic region. Therefore, patients could experience symptoms in the musculoskeletal structures innervated by the same nerve levels at which the visceral afferents converge. The thoracic spine has the highest incidence in the spine for primary neoplasm and metastatic tumours.
Category two findings: The complications of several metabolic disorders manifest themselves in the thoracic spine. Computerized tomographic (CT) scanning is ideal for defining bony changes associated with these disorders, while magnetic resonance imaging (MRI) is the most appropriate for identifying soft tissue lesions.
Category three findings: There is a high incidence of thoracic intervertebral disc lesions typically resulting from trauma, degeneration, lifting or exercise. This requires careful differential assessment as a disc lesion can mimic symptoms of visceral conditions including conditions of the cardiac, pulmonary or renal

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