Claudication
Encyclopedia
Claudication, literally 'limp
ing' (Latin
), is a medical term usually referring to impairment in walking, or pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest. The perceived level of pain from claudication can be mild to extremely severe. Claudication is most common in the calves but it can also affect the feet, thighs, hips, buttocks, or arms. The word "claudication" comes from the Latin "claudicare" meaning to limp.
Claudication that appears after a short amount of walking may sometimes be described by US medical professionals by the number of typical city street blocks the patient can walk before the onset of claudication. Thus, "one-block claudication" refers to claudication that appears after walking one block, "two-block claudication" appears after walking two blocks, etc.
of the blood to the affected area. The poor blood flow is often a result of atherosclerotic blockages
more proximal to the affected area; individuals with intermittent claudication may have diabetes
—often undiagnosed.
of the spinal canal, usually from a degenerative spine, most often at the "L4-L5" or "L5-S1" level
. This may result from many factors, including bulging disc, herniated disc
or fragments from previously herniated discs (post-operative), scar tissue from previous surgeries, osteophytes (bone spurs that jut out from the edge of a vertebra into the foramen, the opening through which the nerve root passes). In most cases neurogenic claudication is bilateral, i.e. on both sides, but it can also be present unilaterally.
or ear
while chewing. This is caused by insufficiency of the arteries supplying the jaw muscles, associated with giant cell arteritis.
Spinal or neurogenic claudication may be differentiated from arterial claudication based on activity and position. In neurogenic claudication, positional changes lead to increased stenosis (narrowing) of the spinal canal and compression of nerve roots and resultant lower extremity symptoms. Standing and extension of the spine narrows the spinal canal diameter. Sitting and flexion of the spine increases spinal canal diameter. A person with neurogenic claudication will have worsening of leg cramping with standing erect or standing and walking. Symptoms may be relieved by sitting down (flexing the spine) or even by walking while leaning over (flexion of the spine) a shopping cart.
The ability to ride a stationary bike for a prolonged period of time differentiates neurogenic claudication from vascular claudication. Weakness is also a prominent feature of spinal claudication that is not usually present in intermittent claudication.
is poor; patients with intermittent claudication due to atherosclerosis are at increased risk of death from cardiovascular disease
(e.g. heart attack), because the same disease that affects the legs is often present in the arteries of the heart.
is FDA approved for intermittent claudication
. Some things to know before use are the following: contraindicated in patient with heart failure, should be taken 30 minutes before or 2 hours after a meal, and improvement of symptoms may not be evident for two to three weeks.
Limp
A limp is a type of asymmetric abnormality of the gait. Limping may be caused by pain, weakness, neuromuscular imbalance, or a skeletal deformity. The most common underlying cause of a painful limp is physical trauma however in the absence of trauma other serious causes such as septic arthritis,...
ing' (Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
), is a medical term usually referring to impairment in walking, or pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest. The perceived level of pain from claudication can be mild to extremely severe. Claudication is most common in the calves but it can also affect the feet, thighs, hips, buttocks, or arms. The word "claudication" comes from the Latin "claudicare" meaning to limp.
Claudication that appears after a short amount of walking may sometimes be described by US medical professionals by the number of typical city street blocks the patient can walk before the onset of claudication. Thus, "one-block claudication" refers to claudication that appears after walking one block, "two-block claudication" appears after walking two blocks, etc.
Intermittent vascular
Intermittent vascular (or arterial) claudication (Latin: claudicatio intermittens) most often refers to cramping pains in the buttock or leg muscles. It is caused by poor circulationCirculatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
of the blood to the affected area. The poor blood flow is often a result of atherosclerotic blockages
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
more proximal to the affected area; individuals with intermittent claudication may have diabetes
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
—often undiagnosed.
Spinal or neurogenic
Spinal or neurogenic claudication is not due to lack of blood supply, but rather it is caused by nerve root compression or stenosisStenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
of the spinal canal, usually from a degenerative spine, most often at the "L4-L5" or "L5-S1" level
Lumbar vertebrae
The lumbar vertebrae are the largest segments of the movable part of the vertebral column, and are characterized by the absence of the foramen transversarium within the transverse process, and by the absence of facets on the sides of the body...
. This may result from many factors, including bulging disc, herniated disc
Spinal disc herniation
A spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...
or fragments from previously herniated discs (post-operative), scar tissue from previous surgeries, osteophytes (bone spurs that jut out from the edge of a vertebra into the foramen, the opening through which the nerve root passes). In most cases neurogenic claudication is bilateral, i.e. on both sides, but it can also be present unilaterally.
Jaw
Jaw claudication is pain in the jawJaw
The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...
or ear
Ear
The ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
while chewing. This is caused by insufficiency of the arteries supplying the jaw muscles, associated with giant cell arteritis.
Differential diagnosis
Vascular (or arterial) claudication typically occurs after activity or ambulation for a distance with resultant vascular insufficiency (lack of blood flow) where the muscular demands of oxygen outweighs the supply. Symptoms are lower extremity cramping. Resting from activity even in a standing position may help relieve the symptoms.Spinal or neurogenic claudication may be differentiated from arterial claudication based on activity and position. In neurogenic claudication, positional changes lead to increased stenosis (narrowing) of the spinal canal and compression of nerve roots and resultant lower extremity symptoms. Standing and extension of the spine narrows the spinal canal diameter. Sitting and flexion of the spine increases spinal canal diameter. A person with neurogenic claudication will have worsening of leg cramping with standing erect or standing and walking. Symptoms may be relieved by sitting down (flexing the spine) or even by walking while leaning over (flexion of the spine) a shopping cart.
The ability to ride a stationary bike for a prolonged period of time differentiates neurogenic claudication from vascular claudication. Weakness is also a prominent feature of spinal claudication that is not usually present in intermittent claudication.
Prognosis
The prognosis for patients with peripheral vascular disease due to atherosclerosisAtherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
is poor; patients with intermittent claudication due to atherosclerosis are at increased risk of death from cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
(e.g. heart attack), because the same disease that affects the legs is often present in the arteries of the heart.
Treatment
PletalPletal
Cilostazol is a medication used in the alleviation of the symptom of intermittent claudication in individuals with peripheral vascular disease. It is manufactured by Otsuka Pharmaceutical Co...
is FDA approved for intermittent claudication
Claudication
Claudication, literally 'limping' , is a medical term usually referring to impairment in walking, or pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest. The perceived level of pain from claudication can be mild to extremely severe. Claudication is most...
. Some things to know before use are the following: contraindicated in patient with heart failure, should be taken 30 minutes before or 2 hours after a meal, and improvement of symptoms may not be evident for two to three weeks.