Red Flags Reference

Red Flags

40 critical findings across all body regions requiring immediate action or urgent referral

Trauma with visible deformity (fracture/dislocation)

Shoulder

Action Required:

X-ray. Reduce dislocation if trained. Immobilize and refer urgently.

Acute traumatic weakness in young patient

Shoulder

Action Required:

Urgent MRI and orthopaedic referral for possible acute rotator cuff tear.

Night pain with weight loss / constitutional symptoms

Shoulder

Action Required:

Exclude malignancy. X-ray, blood tests (ESR, CRP, FBC), consider MRI.

Fever with hot, swollen joint

Shoulder

Action Required:

Exclude septic arthritis. Urgent aspiration, blood cultures, IV antibiotics.

Locked elbow (unable to extend)

Elbow

Action Required:

Possible loose body. X-ray and orthopaedic referral.

Hot, red, swollen olecranon bursa with fever

Elbow

Action Required:

Septic bursitis. Aspirate for culture. Antibiotics.

Progressive hand weakness/wasting

Elbow

Action Required:

Ulnar neuropathy. Urgent nerve conduction studies and surgical referral.

Anatomical snuffbox tenderness after fall

Wrist

Action Required:

Treat as scaphoid fracture until proven otherwise. Thumb spica, repeat X-ray or MRI.

Thenar muscle wasting

Wrist

Action Required:

Severe CTS. Urgent surgical referral for carpal tunnel release.

Penetrating wound with flexor tendon sheath infection signs

Wrist

Action Required:

Kanavel signs = flexor tenosynovitis. URGENT hand surgery referral.

Open tendon laceration

Hand & Fingers

Action Required:

URGENT hand surgery referral within 24 hours. Splint in safe position.

Symmetrical MCP/PIP swelling with morning stiffness >30 min

Hand & Fingers

Action Required:

Suspected RA. URGENT rheumatology referral within 3 weeks. RF, anti-CCP, ESR, CRP.

Bite wound to hand (human or animal)

Hand & Fingers

Action Required:

High infection risk. Antibiotics (co-amoxiclav), tetanus, X-ray. Hand surgery if deep.

Complete UCL tear with Stener lesion

Thumb

Action Required:

Requires surgical repair. Urgent hand surgery referral.

Intra-articular fracture at thumb base

Thumb

Action Required:

Bennett fracture. Urgent orthopaedic/hand surgery referral.

Bilateral hand clumsiness, gait disturbance, hyperreflexia

Neck / Cervical

Action Required:

Cervical myelopathy. URGENT MRI and spine surgery referral.

Progressive neurological deficit

Neck / Cervical

Action Required:

Urgent MRI. Consider cord compression, tumour, or infection.

Neck pain after significant trauma

Neck / Cervical

Action Required:

Canadian C-spine rules. Immobilize. CT cervical spine.

Fever, severe neck stiffness, photophobia

Neck / Cervical

Action Required:

Exclude meningitis. Urgent LP, blood cultures, IV antibiotics.

Bladder/bowel dysfunction, saddle anaesthesia

Low Back

Action Required:

CAUDA EQUINA SYNDROME. EMERGENCY MRI and surgical decompression within 24h.

Progressive bilateral leg weakness

Low Back

Action Required:

Urgent MRI. Possible cord/cauda equina compression.

Age >50, history of cancer, unexplained weight loss, night pain

Low Back

Action Required:

Exclude spinal malignancy. MRI, blood tests (ESR, CRP, PSA, myeloma screen).

Fever, IV drug use, recent infection, immunosuppression

Low Back

Action Required:

Exclude spinal infection (discitis, epidural abscess). Urgent MRI, blood cultures.

Osteoporosis, steroid use, significant trauma, age >70

Low Back

Action Required:

Vertebral compression fracture. X-ray, MRI if malignancy suspected.

Age <40, morning stiffness >30 min, improves with exercise

Low Back

Action Required:

Inflammatory back pain (axial SpA). ESR, CRP, HLA-B27, MRI SI joints. Rheumatology referral.

Fall in elderly, unable to weight-bear, shortened/externally rotated leg

Hip & Groin

Action Required:

Hip fracture. X-ray. URGENT orthopaedic referral for surgical fixation.

Hot, swollen hip with fever (especially in children)

Hip & Groin

Action Required:

Exclude septic arthritis. URGENT aspiration, blood tests, IV antibiotics.

Child with limp and hip/knee pain

Hip & Groin

Action Required:

Exclude Perthes, SCFE, septic arthritis. X-ray both hips (frog-leg lateral). Urgent if febrile.

Groin pain with steroid use, alcohol, or SLE

Hip & Groin

Action Required:

Suspect AVN. MRI femoral head. Early orthopaedic referral.

Locked knee (unable to fully extend)

Knee

Action Required:

Possible displaced meniscal tear or loose body. Urgent MRI and orthopaedic referral.

Rapid swelling within 2 hours of injury

Knee

Action Required:

Haemarthrosis. Likely ACL tear, fracture, or patellar dislocation. X-ray, MRI.

Hot, swollen knee with fever

Knee

Action Required:

Exclude septic arthritis. URGENT aspiration, blood tests, IV antibiotics.

Unable to weight-bear after injury

Knee

Action Required:

Apply Ottawa Knee Rules. X-ray if indicated.

Sudden calf pain with "pop", positive Thompson test

Ankle

Action Required:

Achilles rupture. Equinus position, non-weight-bearing. URGENT orthopaedic referral.

Ottawa rules positive (bony tenderness, unable to weight-bear)

Ankle

Action Required:

X-ray ankle. Splint/immobilize. Orthopaedic referral for displaced fractures.

Open fracture or neurovascular compromise

Ankle

Action Required:

EMERGENCY. IV antibiotics, tetanus, urgent surgical referral.

Midfoot pain with plantar ecchymosis after trauma

Foot

Action Required:

Lisfranc injury. Weight-bearing X-ray, CT. URGENT foot surgery referral.

Diabetic foot with infection signs

Foot

Action Required:

Diabetic foot emergency. Urgent assessment, antibiotics, vascular assessment.

Severe pain out of proportion, pain with passive stretch

Foot

Action Required:

Compartment syndrome. EMERGENCY fasciotomy.

Acute hot, swollen 1st MTP — cannot distinguish gout from septic

Foot

Action Required:

Joint aspiration for crystals and culture. Treat empirically if uncertain.