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Is it neurogenic or vascular claudication?

March 10, 2017
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Intermittent claudication is commonly caused by 2 distinctly different but similarly presenting conditions that can be hard to differentiate clinically: spinal stenosis and vascular insufficiency from peripheral artery disease. The Canadian Journal of Surgery published a study reporting the diagnostic value of symptom combinations in accurately distinguishing between spinal stenosis and arterial disease (1).
Investigators studied 53 patients with confirmed spinal stenosis or peripheral artery disease and concurrent claudication symptoms. The study team reported strong evidence for a confirmed diagnosis occurs when patients have the following constellations of symptoms.

Peripheral Artery Disease
• Pain relieved with standing
• Pain in the calf

Neurogenic Claudication
• Pain triggered with standing
• Pain relieved with sitting
• Pain located above the knees
• Positive shopping cart sign

This study reported positive likelihood ratios, which indicate the strength of a diagnostic test to accurately identify a condition. For peripheral artery disease, the combination of symptoms carries a positive likelihood ratio of 20 while for neurogenic claudication, the combination is supported by a positive ratio of 13. Both ratios indicate high likelihood of diagnostic confirmation.
It would be helpful to see this study reproduced with a larger sample, allowing the research findings to become more generalizable. Nevertheless, recognizing these specific and relatively simple symptom constellations may help avoid unnecessary testing and delayed diagnosis for patients with claudication symptoms.
Reference List
(1) Nadeau M, Rosas-Arellano MP, Gurr KR, Bailey SI, Taylor DC, Grewal R, et al. The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation. Can J Surg 2013 Dec;56(6):372-7.

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