STUDY - Technical - New Dacian's Medicine
Leg pain (Classical / Allopathic Medicine)
Although leg
pain commonly signifies a musculoskeletal disorder, it can
also result from a more serious vascular or neurologic
disorder. The pain may arise suddenly or gradually and may
be localized or affect the entire leg. Constant or
intermittent, it may feel dull, burning, sharp, shooting, or
tingling. Leg pain commonly affects locomotion, limiting
weight bearing. Severe leg pain that follows cast
application for a fracture may signal limb-threatening
compartment syndrome. Sudden onset of severe leg pain in a
patient with underlying vascular insufficiency may signal
acute deterioration, possibly requiring an arterial graft or
amputation. (See Highlighting causes of local leg pain.)
ALERT:
If the patient has acute leg pain and a history of trauma:
- quickly take his vital signs and determine the leg's neurovascular status by assessing distal pulses, skin color, and temperature
- observe his leg position, and check for swelling, gross deformities, or abnormal rotation
- prepare for emergency surgery, if appropriate.
If the patient's condition permits, perform a focused assessment.
If the patient has acute leg pain and a history of trauma:
- quickly take his vital signs and determine the leg's neurovascular status by assessing distal pulses, skin color, and temperature
- observe his leg position, and check for swelling, gross deformities, or abnormal rotation
- prepare for emergency surgery, if appropriate.
If the patient's condition permits, perform a focused assessment.
Highlighting
causes of local leg pain
Various disorders cause hip, knee, ankle, or foot pain, which may radiate to surrounding tissues and be reported as leg pain. Local pain is commonly accompanied by tenderness, swelling, and deformity in the affected area.
Ankle pain; Achilles tendon contracture; Arthritis; Dislocation; Fracture; Sprain; Tenosynovitis;
Various disorders cause hip, knee, ankle, or foot pain, which may radiate to surrounding tissues and be reported as leg pain. Local pain is commonly accompanied by tenderness, swelling, and deformity in the affected area.
Ankle pain; Achilles tendon contracture; Arthritis; Dislocation; Fracture; Sprain; Tenosynovitis;
Knee Pain:
Arthritis; Bursitis; Chondromalacia; Contusion; Cruciate
ligament injury; Dislocation; Fracture; Meniscal injury;
Osteochondritis dissecans; Phlebitis; Popliteal cyst;
Radiculopathy; Ruptured extensor mechanism; Sprain;
Hip pain:
Arthritis; Avascular necrosis; Bursitis; Dislocation;
Fracture; Sepsis; Tumor;
Foot pain: Arthritis; Bunion; Callus or corn; Dislocation; Flatfoot; Fracture; Gout; Hallux rigidus; Hammer toe; Ingrown toenail; Köhler's disease; Morton's neuroma; Occlusive vascular disease; Plantar fasciitis; Plantar wart; Radiculopathy; Tabes dorsalis; Tarsal tunnel syndrome.
HISTORY:
Ask the patient when the pain began and have him describe its intensity, character, and pattern. Is the pain worse in the morning, at night, or with movement? If the pain doesn't prevent him from walking, ask him if he uses a crutch or other assistive device.
Ask the patient if he's experiencing other associated signs and symptoms.
Review the patient's medical history for leg injury or surgery and joint, vascular, or back problems. Also, ask the patient if there's a family history of these disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Foot pain: Arthritis; Bunion; Callus or corn; Dislocation; Flatfoot; Fracture; Gout; Hallux rigidus; Hammer toe; Ingrown toenail; Köhler's disease; Morton's neuroma; Occlusive vascular disease; Plantar fasciitis; Plantar wart; Radiculopathy; Tabes dorsalis; Tarsal tunnel syndrome.
HISTORY:
Ask the patient when the pain began and have him describe its intensity, character, and pattern. Is the pain worse in the morning, at night, or with movement? If the pain doesn't prevent him from walking, ask him if he uses a crutch or other assistive device.
Ask the patient if he's experiencing other associated signs and symptoms.
Review the patient's medical history for leg injury or surgery and joint, vascular, or back problems. Also, ask the patient if there's a family history of these disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT5:
Observe the patient walk, if his condition permits.
Observe how he holds his leg while standing and sitting.
Palpate the legs, buttocks, and lower back to determine the extent of pain and tenderness. If fracture has been ruled out, test range of motion (ROM) in the hip and knee.
Test reflexes with the patient's leg straightened and raised, noting any action that causes pain.
Compare both legs for symmetry, movement, and active ROM. Also, assess pulses, color, sensation, and strength.
If the patient wears a leg cast, splint, or restrictive dressing, carefully check distal circulation, sensation, and mobility, and stretch his toes to elicit associated pain.
Observe the patient walk, if his condition permits.
Observe how he holds his leg while standing and sitting.
Palpate the legs, buttocks, and lower back to determine the extent of pain and tenderness. If fracture has been ruled out, test range of motion (ROM) in the hip and knee.
Test reflexes with the patient's leg straightened and raised, noting any action that causes pain.
Compare both legs for symmetry, movement, and active ROM. Also, assess pulses, color, sensation, and strength.
If the patient wears a leg cast, splint, or restrictive dressing, carefully check distal circulation, sensation, and mobility, and stretch his toes to elicit associated pain.
SPECIAL
CONSIDERATIONS:
If the patient has acute leg pain, closely monitor his neurovascular status by frequently assessing distal pulses, temperature, and color of both legs.
If the patient has acute leg pain, closely monitor his neurovascular status by frequently assessing distal pulses, temperature, and color of both legs.
PEDIATRIC
POINTERS:
Common pediatric causes of leg pain include fracture, osteomyelitis, and bone cancer.
If parents fail to give an adequate explanation for a leg fracture, consider the possibility of child abuse.
Common pediatric causes of leg pain include fracture, osteomyelitis, and bone cancer.
If parents fail to give an adequate explanation for a leg fracture, consider the possibility of child abuse.
PATIENT
COUNSELING:
If the patient has chronic leg pain, advise him on the appropriate anti-inflammatory regimen and teach him to perform ROM exercises. If necessary, teach him how to use a cane, walker, or other assistive device.
If the patient has chronic leg pain, advise him on the appropriate anti-inflammatory regimen and teach him to perform ROM exercises. If necessary, teach him how to use a cane, walker, or other assistive device.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)