Claudication

Question 1

1. What is claudication?

Answer 1

Claudication refers to pain or discomfort in the legs, usually triggered by walking, caused by inadequate blood flow (vascular) or nerve compression (neurogenic).

Question 2

2. What are the two main types of claudication?

Answer 2

The two main types are neurogenic claudication and vascular claudication.

Question 3

3. What is neurogenic claudication?

Answer 3

Neurogenic claudication is leg pain caused by nerve compression or irritation, often associated with lumbar spinal stenosis.

Question 4

4. What is vascular claudication?

Answer 4

Vascular claudication is leg pain caused by reduced blood flow to the muscles, typically due to peripheral arterial disease (PAD).

Question 5

5. What are the common symptoms of neurogenic claudication?

Answer 5

Symptoms include leg pain, tingling, or weakness, often worsened by walking or standing and relieved by sitting or bending forward.

Question 6

6. What are the common symptoms of vascular claudication?

Answer 6

Symptoms include cramp-like leg pain triggered by walking and relieved by rest, usually occurring in the calf muscles.

Question 7

7. What is the aetiology of neurogenic claudication?

Answer 7

It is often caused by lumbar spinal stenosis due to degenerative changes in the spine, leading to nerve compression.

Question 8

8. What is the aetiology of vascular claudication?

Answer 8

It is caused by atherosclerosis leading to peripheral arterial disease (PAD) and reduced blood flow to the muscles.

Question 9

9. What is the pathophysiology of neurogenic claudication?

Answer 9

Compression of the spinal nerves in lumbar stenosis reduces nerve function, causing pain and weakness during activities that narrow the spinal canal, such as walking or standing.

Question 10

10. What is the pathophysiology of vascular claudication?

Answer 10

Atherosclerotic plaques narrow or block arteries, reducing blood supply to muscles during exercise, resulting in ischaemia and pain.

Question 11

11. What is the prevalence of neurogenic claudication?

Answer 11

Neurogenic claudication is more common in older adults due to age-related degenerative changes in the spine.

Question 12

12. What is the prevalence of vascular claudication?

Answer 12

Vascular claudication is common in patients with risk factors for atherosclerosis, such as smokers or individuals with diabetes.

Question 13

13. What are the risk factors for neurogenic claudication?

Answer 13

Risk factors include advanced age, spinal degenerative disease, and spondylolisthesis.

Question 14

14. What are the risk factors for vascular claudication?

Answer 14

Risk factors include smoking, diabetes, hypertension, hyperlipidaemia, and advanced age.

Question 15

15. What are the typical clinical examination findings for neurogenic claudication?

Answer 15

Findings may include reduced range of spinal motion, weakness in lower limbs, and positive findings on neurological testing (e.g., straight leg raise test).

Question 16

16. What are the typical clinical examination findings for vascular claudication?

Answer 16

Findings may include diminished or absent peripheral pulses, cold extremities, and signs of chronic ischaemia (e.g., skin changes or ulcers).

Question 17

17. What investigations are used to diagnose neurogenic claudication?

Answer 17

Investigations include MRI of the lumbar spine to identify spinal stenosis and nerve compression.

Question 18

18. What investigations are used to diagnose vascular claudication?

Answer 18

Investigations include ankle-brachial pressure index (ABPI), Doppler ultrasound, and CT or MR angiography.

Question 19

19. What are the differential diagnoses for neurogenic claudication?

Answer 19

Differential diagnoses include vascular claudication, peripheral neuropathy, and other spinal disorders like disc herniation.

Question 20

20. What are the differential diagnoses for vascular claudication?

Answer 20

Differential diagnoses include neurogenic claudication, deep vein thrombosis, and musculoskeletal disorders such as arthritis.

Question 21

21. What are the conservative management options for neurogenic claudication?

Answer 21

Conservative options include physiotherapy, weight management, and activity modification.

Question 22

22. What are the conservative management options for vascular claudication?

Answer 22

Conservative options include smoking cessation, regular walking programmes, and dietary changes.

Question 23

23. What are the medical management options for neurogenic claudication?

Answer 23

Medical management may involve analgesics, anti-inflammatory medications, or epidural steroid injections.

Question 24

24. What are the medical management options for vascular claudication?

Answer 24

Medical management includes antiplatelet therapy, statins, and medications such as cilostazol to improve blood flow.

Question 25

25. What are the surgical options for treating neurogenic claudication and vascular claudication?

Answer 25

Surgical options for neurogenic claudication include decompression surgery (e.g., laminectomy), while vascular claudication may require angioplasty, stenting, or bypass surgery.