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Differential diagnosis of claudication

Differential diagnosis of claudication
Condition Location of pain or discomfort Character of discomfort Onset relative to exercise Effect of rest Effect of body position Other features
Intermittent claudication Buttock, thigh, or calf muscles and rarely the foot Cramping, aching, fatigue, weakness, or pain After some degree of exercise Quickly relieved None Reproducible
Nerve root compression (eg, herniated disc) Radiates down leg, usually posteriorly Sharp lancinating pain Soon after, if not immediately after onset Not quickly relieved. (Also, often present at rest) Adjusting back position may relieve pain History of back problems
Spinal stenosis Hip, thigh, or buttock (within affected dermatome) Motor weakness more prominent than pain After walking or standing for some length of time Relieved by resting only if position changed Relieved by lumbar spine flexion (sitting or stooping forward) Frequent history of back problems, provoked by intraabdominal pressure
Hip arthritis Hip, thigh, buttocks Aching discomfort, usually localized to hip and gluteal region After variable degree of exercise Not quickly relieved (and may be present at rest) More comfortable sitting (ie, weight taken off legs) Variable, may relate to activity level, weather changes
Arthritic, inflammatory processes Foot, arch Aching pain After variable degree of exercise Not quickly relieved (and may be present at rest) May be relieved by not bearing weight Variable, may relate to activity level
Venous claudication Entire leg, but usually worse in thigh and groin Tight, bursting pain After walking Subsides slowly Relief speeded by elevation of the extremity History of iliofemoral deep vein thrombosis, signs of venous congestion, edema
Adapted from: Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Concensus (TASC). J Vasc Surg 2000; 31:S1.
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