8.24 General Limb Pain

Question 1

What are some conditions that can produce general limb pain (single or multi-limb)

Answer 1

• hypothyroidism
• lyme disease
• statin related myopathies
• vascular/neurogenic claudication
• stress fx
• DVT
• compartment syndrome

Question 2

differentiating neurogenic vs. vascular claudication:

evaluation after walking: neurogenic

Answer 2

increased weakness

Question 3

differentiating neurogenic vs. vascular claudication:

evaluation after walking: vascular

Answer 3

unchanged

Question 4

differentiating neurogenic vs. vascular claudication:

palliative factors: neurogenic

Answer 4

• bending over

- sitting

Question 5

differentiating neurogenic vs. vascular claudication:

palliative factors: vascular

Answer 5

stopping

Question 6

differentiating neurogenic vs. vascular claudication:

provocative factors: neurogenic

Answer 6

• walking downhill

- increased lordosis

Question 7

differentiating neurogenic vs. vascular claudication:

provocative factors: vascular

Answer 7

• walking uphill

- increased metabolic demand

Question 8

differentiating neurogenic vs. vascular claudication:

pulses: neurogenic

Answer 8

present

Question 9

differentiating neurogenic vs. vascular claudication:

pulses: vascular

Answer 9

absent

Question 10

differentiating neurogenic vs. vascular claudication:

“shopping cart sign”: neurogenic

Answer 10

present

Question 11

differentiating neurogenic vs. vascular claudication:

“shopping cart sign”: vascular

Answer 11

absent

Question 12

differentiating neurogenic vs. vascular claudication:

van Gelderen bicycle test: neurogenic

Answer 12

no leg pain

Question 13

differentiating neurogenic vs. vascular claudication:

van Gelderen bicycle test: vascular

Answer 13

leg pain

Question 14

pathological limb pain features: symptoms?

Answer 14

• aching
• cramping
• weakness
• stiffness

Question 15

pathological limb pain features: one or multiple limbs?

Answer 15

often multiple

Question 16

pathological limb pain features: Do symptoms stay in one place or migrate?

Answer 16

often migrate

Question 17

pathological limb pain features: onset

Answer 17

insidious

Question 18

pathological limb pain features: mechanical pattern?

Answer 18

non-mechanical pattern

Question 19

pathological limb pain features: stiffness

Answer 19

prolonged morning stiffness longer than 30 mins

Question 20

multi-limb complaints: spinal origin

Answer 20

central cord compression

Question 21

multi-limb complaints: systemic disease

possible origins

Answer 21

• hypothyroidism
• Lyme disease
• polymyalgia rheumatica
• statin drugs