Differentials
Spinal stenosis
SIGNS / SYMPTOMS
Patients with history of back pain complain of hip, thigh, buttock, or leg pain. It is usually in a dermatomal distribution and may be associated with motor weakness. The pain may occur on standing alone and is relieved by position change such as sitting or stooping forwards (lumbar spine flexion).
INVESTIGATIONS
Ankle-brachial index (ABI) will be normal and exercise ABI will show no decrease in post-exercise ABI.
No significant disease seen with arterial imaging tests.
Plain spinal x-ray: degenerative changes or spondylolisthesis.
MRI spine: compression of the neural elements and soft tissue.
Arthritis
SIGNS / SYMPTOMS
Patients complain of hip, thigh, or buttock pain that is localised to hip and gluteal region. It can occur at rest or starts after exercise and is not quickly relieved.
INVESTIGATIONS
Ankle-brachial index (ABI) will be normal and exercise ABI will show no decrease in post-exercise ABI.
No significant disease seen with arterial imaging tests.
X-ray of affected joint: new bone formation (osteophytes), joint space narrowing, and subchondral sclerosis and cysts.
Venous claudication
SIGNS / SYMPTOMS
Patients often have a history of iliofemoral deep venous thrombosis, signs of venous congestion, and oedema. They may complain of entire leg pain that is usually worse in the thigh and groin region. The pain is described as tight or bursting, and starts after walking and is relieved slowly. Pain relief usually occurs once the leg is elevated.
INVESTIGATIONS
Ankle-brachial index (ABI) will be normal and exercise ABI will show no decrease in post-exercise ABI.
No significant disease seen with arterial imaging tests.
Chronic compartment syndrome
SIGNS / SYMPTOMS
Occurs in athletes. They complain of tight bursting calf pain after exercise that subsides slowly after leg elevation. Usually these patients are very muscular.
INVESTIGATIONS
Duplex ultrasound scanning will show no significant arterial stenosis.
Compartment pressure measurement: differential pressure ≤20 mmHg.
Symptomatic Baker's cyst
SIGNS / SYMPTOMS
Patients complain of pain in the calf and behind the knee. The area may be swollen, sore, and tender. The pain is present at rest and worse with exercise.
INVESTIGATIONS
Ankle-brachial index (ABI) will be normal and exercise ABI will show no decrease in post-exercise ABI.
No significant disease seen with arterial imaging tests.
Duplex ultrasound of the leg: cystic mass in the posterior-medial popliteal fossa.
Nerve root compression
SIGNS / SYMPTOMS
Patients have pain that radiates down the leg. Often have a history of back problems.
INVESTIGATIONS
Ankle-brachial index (ABI) will be normal and exercise ABI will show no decrease in post-exercise ABI.
No significant disease seen with arterial imaging tests.
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