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Sciatica (lumbar radiculopathy) - Management
Interpreting 'red flags'
- Red flags are indicators of increased risk of serious pathology — they do not always indicate that a specific condition is present.
- For example, pain that remains when lying supine does not mean that the person has cancer or infection of the spine. But it does mean that these conditions should be more readily suspected.
- Further investigation and referral with appropriate urgency may be indicated, and should always be considered, if one or more red flags are present.
- Clinical judgement should be used to decide how urgently to refer when red flags suggest a serious condition. The presence of red flags does not always mean that emergency admission is required (serious does not always mean an emergency).
- For example, cauda equina syndrome would usually warrant immediate admission, but referral to be seen within a few days might be appropriate for suspected cancer secondaries in the spine.
- Serious underlying pathology is not common.
- Red flags should be explicitly looked for. For example, the person may not report symptoms such as perineal numbness unless asked.
- For more information on causes of sciatic symptoms, see Differential diagnosis.
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