Isolated Extremity Pain – a Case Presentation

Research into practice!

In a recent presentation on Trust me-Ed, you were introduced to the research on ‘Isolated Extremity Pain – should we check the spine?’ 

The EXPOSS study and the follow-up EXPOSS predictor study begin to explore if the old assumptions we make about ‘excluding the spine’ stand up to scrutiny. These studies provide some data on how to differentiate extremity from spinal problems. This should help guide the decision-making process as to where our management needs to be focused.

The following video demonstrates how we can put this research into practice. You’ll be taken through the example of a patient with an elbow presentation, where the spine is screened to see if it influences the extremity baselines, and the decision is ultimately made as to where the focus of management should be. You’ll see that the process is not a lengthy or complex one, and much is already included in a standard orthopedic assessment. So, this process can be included in the assessment and clinical thinking of clinicians with different approaches and perspectives. The important aspect is that we only spend limited resources focusing our treatment on the extremity if the problem is indeed a local one, if it is the spine that can change these local symptoms in a positive way, then this is where our focus should be.

So, please join us for this practical, step-by step video, that guides the clinician through the simple process of spinal / extremity differentiation for isolated extremity pain presentations. Let’s start to question some of those old assumptions and start to be guided in our clinical reasoning and assessment on some research.

Learning Points

After viewing this video, you will be able to:

• Apply the spinal / extremity differentiation research to your everyday practice for your patients presenting with isolated extremity symptoms.
• Recognize that screening the spine in cases of isolated extremity pain can be seamlessly integrated into any musculoskeletal assessment.
• Demonstrate the practical steps needed to adequately screen the spine for presentations of isolated extremity pain.
• Value the importance of keeping the patient appraised of the purpose and steps to the differentiation process, ensuring an informed and collaborative process.
• Interpret the findings from the differentiation assessment and determine the best strategy for patient management