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Neurogenic claudication must be differentiated from other causes of leg pain, which may be present in a number of conditions involving the spine and musculoskeletal system. The differential diagnosis for NC includes: [9] Vascular claudication; Lumbosacral radicular pain secondary to lumbar disc herniation
Angiograms of a patient diagnosed with popliteal artery entrapment syndrome of the left lower extremity. Image A shows a neutral popliteal artery before provocative maneuvers. Images B and C show the obstruction (orange arrows) enhanced with provocative maneuvers of plantar flexion and dorsiflexion, respectively.
Claudication is a medical term usually referring to impairment in walking, or pain, discomfort, numbness, or tiredness in the legs that occurs during walking or standing and is relieved by rest. [1] The perceived level of pain from claudication can be mild to extremely severe.
Low back pain accounts for 17% of all physician visits of people aged 65 and older. [37] From this population, a large portion of radicular pain stems not from disk pathology, but from lumbar spinal stenosis. [37] According to Kalff et al., 21% of people over the age of 60 have lumbar spinal stenosis, as confirmed by radiological screening. [38]
Intermittent claudication is a symptom and is by definition diagnosed by a patient reporting a history of leg pain with walking relieved by rest. However, as other conditions such as sciatica can mimic intermittent claudication, testing is often performed to confirm the diagnosis of peripheral artery disease .
Critical limb ischemia is diagnosed by the presence of ischemic rest pain, and an ulcers that will not heal or gangrene due to insufficient blood flow. [3] Insufficient blood flow may be confirmed by ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oxygen measurement (TcpO2 ), or skin perfusion pressure (SPP).
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Of patients with intermittent claudication, only "7% will undergo lower-extremity bypass surgery, 4% major amputations, and 16% worsening claudication", but stroke and heart attack events are elevated, and the "5-year mortality rate is estimated to be 30% (versus 10% in controls)". [84]
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