Claudication

Question 1

OSOCRATES

Answer 1

Open- tell me about the pain
Site- point to where the pain is eg. Buttock, calf, thigh
Onset- sudden or gradually
Character- what does it feel like
Radiation- what does the pain feel like
Associated features- pain at night/ any painful ulcers on feet
Timing- do you get pain when walking/ any previous episodes
Exacerbating and relieving factors- relieved by rest/ made worse if you walk fast or up a hill/ does cold weather affect it
Severity- how badly does it affect you/ how far can you go without stopping/ do you want something done about it

Question 2

PMH

Answer 2

HTN, hypercholesterolaemia, DM, ACS, previous stroke, HTN

Question 3

FH

Answer 3

CVD that runs in the family

Question 4

SH

Answer 4

Do you or anybody at home smoke- second hand smokers can get COPD/ other conditions

Question 5

Tips

Answer 5

Claudication doesn’t happen at rest- that would be critical limb ischaemia
Ask about claudication distance

Question 6

PVD

Answer 6

Brought on by exercise and relieved by rest
Exacerbated by hills and cold weather
Risks- DM/ hypercholesterolaemia/ stroke/ ischaemic heart problems/ HTN/ arrhythmia

Question 7

DVT

Answer 7

Tender swollen warm leg
Acute
Different risk factors

Question 8

MSK injury

Answer 8

History of preceding injury

Localised pain and tenderness

Question 9

Investigations for claudication

Answer 9

Full peripheral vascular, cardiovascular and neurological examination
Bloods- FBC UE glucose lipid profile
OBS- BP etc
ABPI and Doppler pulses
CT angiography (metformin and contrast media)

Question 10

Management of claudication

Answer 10

Stop smoking
Exercise- collateral circulation
Point out alternative ways of getting from A to B eg, bus
Secondary risk prevention medications eg. Statin, antiplatelet
Unless severe disease- trial of conservative management and reassess in 6 months
Surgery- bypass or angioplasty

NB- if having contrast media, no metformin as may cause renal failure

Question 11

Patients perspective

Answer 11

Feelings and impact on life

ICE

Question 12

OA

Answer 12

Pain localised to feet, ankles, knees (joints), not calves
Often pain elsewhere (hands and neck)
Commonly co exists with claudication
Not brought on by walking a certain. Distance and that is the case with claudication

Question 13

Sciatica

Answer 13

Shooting pain down back of leg to the feet

History of lower back pain

Question 14

Spinal claudication (stenosis)

Answer 14

Often relived when walking uphill and leaning forward

Often has associated numbness