RT Journal Article
SR Electronic
T1 The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 372
OP 377
DO 10.1503/cjs.016512
VO 56
IS 6
A1 Mélissa Nadeau
A1 M. Patricia Rosas-Arellano
A1 Kevin R. Gurr
A1 Stewart I. Bailey
A1 David C. Taylor
A1 Ruby Grewal
A1 D. Kirk Lawlor
A1 Chris S. Bailey
YR 2013
UL http://canjsurg.ca/content/56/6/372.abstract
AB Background: Intermittent claudication can be neurogenic or vascular. Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication.Methods: Patients with a diagnosis of lumbar spinal stenosis (LSS) or peripheral vascular disease (PVD) who reported claudication answered 14 questions characterizing their symptoms. We determined the sensitivity, specificity and positive and negative likelihood ratios (PLR and NLR) for neurogenic and vascular claudication for each symptom attribute.Results: We studied 53 patients. The most sensitive symptom attribute to rule out LSS was the absence of “triggering of pain with standing alone” (sensitivity 0.97, NLR 0.050). Pain alleviators and symptom location data showed a weak clinical significance for LSS and PVD. Constellation of symptoms yielded the strongest associations: patients with a positive shopping cart sign whose symptoms were located above the knees, triggered with standing alone and relieved with sitting had a strong likelihood of neurogenic claudication (PLR 13). Patients with symptoms in the calf that were relieved with standing alone had a strong likelihood of vascular claudication (PLR 20.0).Conclusion: The classic symptom attributes used to differentiate neurogenic from vascular claudication are at best weakly valid independently. However, certain constellation of symptoms are much more indicative of etiology. These results can guide general practitioners in their evaluation of and investigation for claudication.