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Leg Pain

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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Associated Diseases
BETA

Cardiovascular
Musculoskeletal
Arthropathies
Soft Tissue Disorders
Other
Disorders of Bone & Cartilage
Trauma
Other
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