Medical Screening


Axial Spondylarthritis (AxSpa) screening

This is based on the SPADE tool by Zoe Clark Osteopath.

  • Did your back pain and stiffness start before the age of 45?
  • Did your pain and stiffness develop gradually, with symptoms persisting at least three months?
  • Does your pain and stiffness tend to ease with physical activity and exercise?
  • Do you find there is no improvement in your back pain when you rest?
  • Do you suffer from increased back pain and discomfort when immobile during sleep, and start to feel better once up and moving?
  • Does the pain improve with NSAIDs?
  • Do you experience fatigue?
  • Do you have/have you had heel pain (enthesitis)?
  • Do you have peripheral arthritis/other joint pains or swellings? Do you have/have you had dactylitis?
  • Do you have a history of iritis/uveitis?
  • Do you have psoriasis?
  • Do you have inflammatory bowel disease (Crohn’s or Ulcerative Colitis)?
  • Do you have a family history of: - Axial SpA? - Reactive Arthritis? - Psoriasis? - IBD (Crohn’s or Ulcerative Colitis)? - Uveitis?
  • Have you had a blood test for ESR or CRP? If so, were they raised?
  • Are you HLA-B27 positive?
  • Do you have sacroiliitis shown by MRI?

Osteoporosis screening

This work is based on the FRAX tool

There are several factors generally accepted to be risk factors in osteoporosis and related fractures. These include:

  • Genetics: Check your family history.
  • Gender: Osteoporosis is not exclusively a female disease but it is more prevalent in women.
  • Age: The older you are the higher the risk. Bone loss starts between 20 and 40 but increases in later life.
  • Body weight: You need to carry a bit of weight! Those with a body mass index less than 19kg/m sqd are more likely to get osteoporosis.
  • Previous fracture: If you have sustained a previous fracture either spontaneously or from a trauma, which, in a healthy individual, would not normally result in a fracture then there’s more risk of it happening again.
  • Alcohol: The NHS advise there is no safe level of alchol consumption but to not exceed 14 units a week. 3+ units a day increases your likelihood of developing osteoporosis.
  • Smoking: Smoking increases your chance of osteoporosis.
  • Steroids (glucocorticoids): If you’ve been taking a daily dose of 5+mg prednisolone for more than 3 months there is a risk of developing osteoporosis. Do not come off your medication consult with your GP.
  • Other illnesses: Illnesses associated with osteoporosis are: rheumatoid arthritis (not ‘wear and tear’ osteoarthritis), bone cancer, multiple myeloma, Cushing’s disease, type I diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (before 45), chronic malnutrition, or malabsorption and chronic liver disease.

Hypermobility screening

Risk factors: family history of EDS or hypermobility, Just GAPE questions: Joints and (U)other Soft Tissues, Gut, Allergy/atopy/autoimmune, Postural Symptoms, Exhaustion.

Beighton score >4:

  • Passive hyperextension of the 5th MCP beyond 90 degs.
  • In wrist flexion the thumb touches the forearm.
  • Hyperextension of the eblow 10+ degs.
  • Passive extension of the knee 10+ degs.
  • In forward flexion the hands touch the floor.