2_Lecture 1A_Red & Yellow flags

Red flags are indicators that suggest the presence of serious underlying conditions that may require immediate medical attention. Examples include:

• Unexplained weight loss
• History of cancer
• Severe pain that is not relieved by rest
• Recent trauma or injury
• Neurological symptoms such as weakness or numbness

Yellow flags are psychosocial factors that may indicate an increased risk of chronic pain or disability. Examples include:

• Catastrophizing thoughts about pain
• Fear-avoidance behavior
• Low mood or anxiety
• Poor social support
• Previous negative experiences with healthcare

The presence of red flags can significantly impact treatment decisions by:

1. Prompting immediate referral to a physician or specialist.
2. Altering the treatment plan to ensure safety and appropriateness.
3. Guiding the physical therapist in monitoring the patient's condition closely.

Recognizing red flags is crucial for ensuring patient safety and effective management of serious conditions.

Yellow flags can influence the recovery process by:

• Indicating potential barriers to recovery, such as psychological distress.
• Guiding interventions that address psychosocial factors, such as cognitive-behavioral therapy.
• Helping therapists develop a more comprehensive treatment plan that includes education and support for the patient.

Addressing yellow flags is essential for improving outcomes and preventing chronicity.

The purpose of screening for red flags is to identify serious pathologies that require immediate medical attention and to recognize conditions that fall outside the scope of musculoskeletal physiotherapy intervention.

Yellow flags indicate pain associated with psychological distress. Screening for yellow flags is important to identify patients who may be at risk for delayed recovery due to psychosocial factors affecting their condition.

Red flags are signs or symptoms identified during the patient interview and clinical examination that may suggest a serious condition or pathology. They indicate the need for further questioning or investigations and may signal precautions or contraindications to assessment or treatment.

Constant progressive, non-mechanical pain is characterized by:

• No relief with bed rest
• Often indicates serious underlying pathology

Examples of non-mechanical pain disorders include:

• Persistent night pain
• Severe unremitting pain
• Pain unaffected by medication or position
• Severe pain with no history of injury
• Severe spasm
• Bladder and bowel dysfunction associated
• Not responding to treatment (Rx)

Examples of red flags include:

• Constant progressive, non-mechanical pain (no relief with bed rest)
• Systemically unwell
• Unexplained weight loss
• Fever
• Deep aching, throbbing
• Jaundice
• Skin rash
• Fatigue
• Low grade fever

The red flags to screen for include:

1. Tumour:

   • History of cancer
   • Symptoms/signs of cancer
   • Unexplained deformity, mass, or swelling
   • Progressive pain unrelated to movement, often predominant at night
   • Pain not reproduced by palpation or movement during examination

2. Infection:

   • Red skin
   • Fever
   • Systemically unwell

3. Neurological lesion:

   • Unexplained wasting
   • Significant sensory or motor deficits

4. Pulmonary or vascular compromise:

   • Shortness of breath (SOB)
   • Cough
   • Blood in sputum

Key indicators include:

1. Acute rotator cuff muscle tear:

   • Recent trauma
   • Acute disabling pain
   • Significant weakness

2. Unreduced shoulder dislocation:

   • Trauma
   • Epileptic seizure
   • Loss of rotation
   • Abnormal shape of shoulder

3. Young adult with acute traumatic primary anterior shoulder dislocation

4. Undiagnosed severe shoulder pain:

   • Non-mechanical in nature

• Cervical spine disorders
• Thoracic spine disorders
• Nerve disorders or radiculopathy, nerve entrapments or injury
• Inflammatory disorders (e.g., rheumatoid arthritis)
• Visceral disorders (heart, lungs, gallbladder, diaphragm, spleen, kidney)
• Complex regional pain syndrome (severe burning pain, not responding to analgesia)

Screening helps identify potential red flags and yellow flags that may indicate serious underlying conditions or psychosocial factors affecting recovery. It ensures that the physical therapist can make informed decisions about the patient's treatment plan and referral needs.

Common red flags include:

1. Unexplained weight loss
2. History of cancer
3. Recent trauma or injury
4. Neurological symptoms (e.g., numbness, weakness)
5. Fever or signs of infection

These indicators may suggest serious pathology that requires further investigation.

Yellow flags are psychosocial factors that may indicate an increased risk of chronic pain or disability. Examples include:

• Fear-avoidance beliefs
• Catastrophizing
• Low mood or anxiety
• Poor social support

Recognizing these factors is crucial as they can influence the patient's recovery and response to treatment.

Physical therapists play a critical role in:

• Identifying red and yellow flags during assessment
• Establishing a diagnosis based on clinical findings
• Developing a tailored treatment plan that addresses both physical and psychosocial aspects of recovery
• Making referrals to other healthcare professionals when necessary

This comprehensive approach enhances patient outcomes and ensures safety in treatment.

Yellow flags are psychological, workplace, environmental, and social factors that increase the risk of an injured worker developing or perpetuating long-term disability, incapacity for work, and prolonged musculoskeletal pain.

Yellow flags are psychosocial factors that may indicate a risk of prolonged disability or chronic pain. They include:

• Belief that pain is harmful or potentially severely disabling
• Fear-based avoidance behavior, leading to reduced levels of activity, such as avoiding movements due to misplaced anticipation of pain
• Tendency for low mood and withdrawal from activities
• Expectation to be 'fixed', indicating a lack of self-efficacy.

Examples of yellow flags include:

• Poor appetite
• Belief that pain indicates something dangerous: "I wouldn't have this much pain if there weren't something potentially dangerous going on in my body."
• Obsessive thoughts about pain: "I can't seem to keep it out of my mind."
• Avoidance of physical activities: "I cannot do physical activities which (might) make my pain worse."
• Perceived heavy workload: "My work is too heavy for me."
• Emotional barriers to therapy: "I cannot do my therapy no matter how I feel emotionally."