Osteoarthritis (hip, knee)
Exercise-related pain (e.g. Achilles tendonitis), muscular injury (e.g. hamstring)
Serious disorders not to be missed
peripheral vascular disease
arterial occlusion (embolism)
thrombosis popliteal aneurysm
deep venous thrombosis
Spinal canal stenosis → neurogenic claudication
Greater trochanteric pain syndrome
Nerve entrapment (e.g. meralgia paraesthetica)
Iatrogenic: injection into nerve
Complex regional pain syndrome I
Is the patient trying to tell me something?
Quite possible. Common with work-related injuries.
Is the pain acute or chronic onset?
Did it follow trauma or activity?
Is it ‘mechanical’ (related to movement)?
Is it postural?
Is it related to walking?
Is the pain arising from bone or from a joint?
Past history, especially cardiovascular, back pain, trauma history.
Watch the patient walk and assess the nature of any limp. Note the posture of the back and examine the lumbar spine. Have both legs well exposed for inspection
Palpate for local causes of pain and if no cause is evident examine the spine, blood vessels and bone. Note the temperature of the feet and legs
Perform a vascular examination including the peripheral pulses and veins
Consider a neurological examination to test nerve root lesions or entrapment neuropathies
Examine the joints, especially the hip and sacroiliac joints
FBE and ESR
radiology: plain X-ray, knee, hip, lumbosacral spine; CT or MRI, bone scan
vascular studies: arterial tree or venous system.
Pain that does not fluctuate in intensity with movement, activity or posture has an inflammatory or neoplastic cause.
Varicose veins can cause aching pain in the leg.
Older people may present with claudication in the leg from spinal canal stenosis or arterial obstruction or both.
Think of the ...
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