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Diagnosis of Intermittent Vascular Claudication in a Patient With a Diagnosis of Sciatica

JC Gray, PT, OCS, FAAOMPT, is a clinical specialist in orthopedic manual therapy practicing at Sharp Rees-Stealy, San Diego, Calif. He is a member of the faculty of the Ola Grimsby Institute, San Diego, Calif. Address all correspondence to Mr Gray at 13364 Corte Playa Cancun, San Diego, CA 92124-1539 (USA) (jcgray{at}ucsd.edu)

Background and Purpose. The purpose of this case report is to illustrate the importance of medical screening to rule out medical problems that may mimic musculoskeletal symptoms. Case Description. This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. She also reported numbness in her left leg after walking, sensations of cold and then heat during walking, and cramps in her right calf muscle. She did not report any leg pain. A medical screening questionnaire revealed an extensive family history of heart disease. Examination of the lumbar spine and nervous system was negative. A diminished dorsalis pedis pulse was noted on the left side. Stationary cycling in lumbar flexion reproduced the patient's complaints of lower-extremity weakness and temporarily abolished her dorsalis pedis pulse on the left side. Outcomes. She was referred back to her physician with a request to rule out vascular disease. The patient was subsequently diagnosed, by a vascular specialist, with a "high-grade circumferential stenosis of the distal-most aorta at its bifurcation." Discussion. This case report points out the importance of a thorough history, a medical screening questionnaire, and a comprehensive examination during the evaluation process to rule out medical problems that might mimic musculoskeletal symptoms.

Key Words: Differential diagnosis • Sciatica • Vascular claudication

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