Red flags useful to screen for gastrointestinal and hepatic diseases in patients with shoulder pain: A scoping review

Pennella, Denis; Giagio, Silvia; Maselli, Filippo; Giovannico, Giuseppe; Roncone, Antonella; fiorentino, f.

doi:10.1002/msc.1628

Cited by 21 publications

(17 citation statements)

References 68 publications

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“…In this regard, we believe it is fundamental that the clinical framework follow a rational construct capable of: Analysing any red flags to analyse the presence of situations that imply a non-musculoskeletal problem. In this case, the patient needs to be referred to the doctor for the most appropriate diagnostic investigations (screening for referral) [ 62 , 63 , 64 , 65 ]; Guiding the clinician in determining whether there is a structure predominantly involved in and responsible for the lateral musculoskeletal disorder of the elbow (muscle–tendon, joint, neural) capable of influencing the prognosis and the type of treatment (conservative and/or surgical); and Recognising profiles of patients who, depending on the time of suffering, may present the risk of developing yellow flags capable of slowing down or altering the treatment process and/or deteriorating adherence to the therapeutic plan. …”

Section: Discussionmentioning

confidence: 99%

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Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews

et al. 2022

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Background: Lateral elbow pain (LEP) represents a musculoskeletal disorder affecting the epicondyloid region of the elbow. The terminological framework of this problem in literature, to date, is confusing. This systematic review (SR) aims to analyse the panorama of the scientific literature concerning the pathogenetic framework, treatment, and clinical diagnosis of LEP. Methods: We conducted an SR according to the guidelines of the PRISMA statement. We performed research using the electronic Medline, Epistemonikos, and Cochrane Library databases. The research started on 12 January 2022 and finished on 30 April 2022. We included all systematic reviews and meta-analyses published, in English, between 1989 and 2022. The articles’ selection was based on critical appraisal using Amstar 2. In the selected reviews we obtained the etiopathogenic terminology used to describe the symptoms, treatment, and diagnostic criteria of LEP. Results: Twenty-five SRs met the eligibility criteria and were included in the study. From these SRs, 227 RCT articles were analysed and different treatments proposals were extracted, such as exercise, manipulation corticosteroid injection, and surgery. In the selected articles, 10 different terms emerged to describe LEP and 12 different clinical tests. The most common treatments detected in this SR were a conservative multimodal approach (e.g., eccentric exercises, manual therapy, acupuncture, ultrasound), then surgery or other invasive treatments (e.g., corticosteroid injection, tenotomy). The most common term detected in this SR was “lateral epicondylitis” (n = 95, 51.6%), followed by “tennis elbow” (n = 51, 28.1%) and “lateral epicondylalgia” (n = 18, 9.4%). Among the diagnostic tests were painful palpation (n = 101, 46.8%), the Cozen test (n = 91, 42.1%), the pain-free grip-strength test (n = 41, 19.0%), and the Maudsley test (n = 48, 22.2%). A total of 43.1% of RCTs (n = 96) included subjects with LEP > 3 months, 40.2% (n = 85) included patients with LEP < 3 months, and 16.7% of the items (n = 35) were not specified by the inclusion criteria on the onset of symptoms. Conclusions: In this SR, a considerable terminological heterogeneity emerged in the description of LEP, associated with the lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain.

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Section: Discussionmentioning

confidence: 99%

“…Analysing any red flags to analyse the presence of situations that imply a non-musculoskeletal problem. In this case, the patient needs to be referred to the doctor for the most appropriate diagnostic investigations (screening for referral) [ 62 , 63 , 64 , 65 ];…”

Section: Discussionmentioning

confidence: 99%

Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews

et al. 2022

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“…A thorough analysis of these information improves the likelihood of ruling in or ruling out the presence of red flags [ 30 ]. Notably, the patient’s medical history is the cornerstone in PT assessment [ 24 ]. Obtaining information about the clinical condition of a patient with apparent musculoskeletal disorders [ 31 ] facilitates the PT’s job and reduces the incidence of serious and misdiagnosed pathologies [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Both anamnestic collection and physical examination revealed red flags [ 24 ], which suggested an extra-professional pathology. The PT wrote a letter describing the main features of the patient’s medical history and clinical examination and referred the patient for neurosurgical consultation.…”

Section: Referralmentioning

confidence: 99%

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

Brindisino

Scrimitore

Pennella

et al. 2022

IJERPH

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Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10–12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist’s clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient’s lumbosacral tract. The therapeutic intervention included the patient’s post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients’ assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.

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“…1 RFs are "signs and symptoms that raise suspicion of serious pathology". 4,5 RFs reported during a medical history or discovered during physical examination are associated with a higher prevalence of serious conditions that may be related to back pain. 6 Therefore, knowing these RFs helps early diagnosis and proper management of serious conditions.…”

Section: Introductionmentioning

confidence: 99%

Management of Low Back Pain in Primary Health-Care Settings: Physician’s Awareness and Practices Based on Red Flags

Arishy¹,

Mahfouz²,

Khalafalla³

et al. 2022

JMDH

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Background: Low back pain (LBP) is one of the most common health problems. Red flags (RFs) of LBP are risk factors that are reported during clinical assessment to determine serious illness. This study aimed to assess primary health-care physicians' knowledge of and practices for RFs of LBP and identify variables associated with a high level of knowledge and awareness about it. Methods: An observational cross-sectional survey was conducted in 2021 among a random sample of 261 primary health care (PHC) physicians in the Jazan Region in southwest Saudi Arabia. A web-based questionnaire was used to collect data on LBP red flags awareness and practices. Descriptive (frequency and percentage) and inferential statistics were used for data analysis. Results:The overall mean score of RFs knowledge among physicians was 82.33 ± 36.3, with 95% confidence interval (CI); (77.7-86.9). Regarding the Physician's practices, more than 95% of the participants would refer patients to higher levels in the presence of symptoms or signs of RFs. General practitioners and residents were significantly more likely to ask for an Xray, even with symptoms that had persisted for less than 2 weeks without RF signs (p = 0.006). The overall percentage of patients with nonspecific LBP referrals was as high as 57.8%. The number of patients with LBP seen per month (fewer than 15) and female physician were associated with an increased level of knowledge (OR = 2.2, 95%, P < 0.05) and (OR = 2.2, 95%, P < 0.05) respectively. Conclusion: Overall, awareness of RFs for LBP and referring critical patients who present with LBP is good among PHC physicians in the Jazan Region. Junior physicians have a low threshold to request images. The referral rate for nonspecific LBP is still high, which could overwhelm spinal clinics. Further educational programs for back pain management are recommended.

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Red flags useful to screen for gastrointestinal and hepatic diseases in patients with shoulder pain: A scoping review

Cited by 21 publications

References 68 publications

Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews

Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

Management of Low Back Pain in Primary Health-Care Settings: Physician’s Awareness and Practices Based on Red Flags

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