Assessment, Diagnosis and Management (ADAM) tool - serious/specific pathology

Red flag screening questions for:

• Emergency conditions including cauda equina syndrome.
• Signs of sinister pathology.
• Signs of myelopathy.
• Signs of specific pathologies – inflammatory disease, osteoporotic fracture.

Mechanism of onset including trauma.
Severity and longevity of symptoms.
Limitation to function.

Check for facial asymmetry, spinal deformity including scoliosis, muscle wasting, lumps, obvious leg length discrepancy, bony tenderness.

Spinal range of movement, check shoulder for neck pain, hip for lumbar pain.

Reflexes, sensation, power, pulses.
Lhermitte’s sign.
Upper motor neurone tests if indicated.

For red flags – bloods,
Imaging rarely required as first line assessment in primary care.
Plain X-ray indicated for suspected osteoporotic wedge fracture.

• Consider cranio-cervical instability particularly in patients with Rheumatoid Arthritis, Down’s syndrome, Ehler’s-Danlos syndrome.
• Neurological disorders.
• Vascular disorders.
• Acute torticollis.
• Parsonage-Turner Syndrome (brachial neuritis)
• Peripheral nerve entrapment.
• Respiratory and visceral conditions.
• Urological, gynaecological causes.

In absence of red flags:-

• Provide reassurance and advice regarding positive prognosis.
• Links to self-management.
• Analgesia/pain management.
• Reassure safe to move and beneficial to remain active.
• Safety net for deteriorating signs.

Not appropriate for MSK, refer to appropriate secondary care services.