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Symptoms
 
 

Leg Pain

 
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Overview

Pain in the lower limbs is a non-specific symptom that may be due to traumatic, vascular, neurologic, rheumatologic, infectious or malignant pathology.

Aetiology

  • Causes of Leg Pain

  • Arterial - acute occlusion, claudication
  • Venous - deep venous thrombosis, superficial thrombophlebitis
  • Neurological - spinal stenosis, radiculopathy
  • Trauma - soft tissue injury, fracture, dislocation, compartment syndrome
  • Arthritis - osteoarthritis, rheumatoid arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis
  • Infection - cellulitis, osteomyelitis, septic arthritis
  • Malignancy - osteosarcoma, bone metastasis

History of Presenting Complaint

  • Site

    Whether the pain is in the thigh / calf / ankle, and whether it affects one leg or both.
  • Pain tracking along a veinSuggestive of superficial thrombophlebitis
  • Onset

    Whether the pain came on suddenly or gradually, and whether it began after trauma.
  • Sudden onset severe painSuggestive of acute arterial occlusion or acute disc herniation
  • Onset post traumaSuggestive of fracture or soft tissue injury
  • Onset post superficial injury / drug injectionSuggestive of cellulitis +/- osteomyelitis
  • Character

    The type of pain - sharp, dull, tight or burning.
  • Deep, constant acheRed flag for bone tumour
  • Extreme tight sensationLook for compartment syndrome
  • Radiation

    Whether the pain radiates anywhere else.
  • Burning pain radiating down the legSuggestive of radiculopathy
  • Associated Symptoms

    Whether the pain is associated with any other symptoms.
  • Redness, warmth and tendernessSuggestive of cellulitis or DVT
  • Numbness / paraesthesiaSuggestive of spinal stenosis / radiculopathy
  • Coolness and paraesthesiaRed flag for acute arterial occlusion
  • Lower back painSuggestive of spinal stenosis / radiculopathy
  • Dyspnoea / chest painMay suggest DVT with PE
  • Timing

  • How long the pain has been going on for, and whether varies throughout the day.
  • Exacerbating Factors

    Whether there is anything that makes the pain worse.
  • Worse with exerciseSuggestive of arterial insufficiency (claudication)
  • Worse with movementMay be suggestive of spinal stenosis or radiculopathy
  • Alleviating Factors

    Whether there is anything that relieves the pain, and whether the patient has taken analgesia.
  • Relieved with restSuggestive of arterial insufficiency (claudication)
  • Severity

  • How severe the pain is on a scale of 1 to 10, with 10 being the worst pain
  • Whether the patient is able to walk
  • How the pain is affecting the patient’s daily life
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