Limping Patient/PGS (VPL)

Diagnostics

 * Skin color and temperature:
 * pinkish cold (arterial circulation disorders);
 * flushed hot (DVT);
 * red streak (thrombophlebitis);
 * reddened swollen joints (arthritis - gout, rheumatoid arthritis, rheumatic fever).
 * Difference in the circumference of the calf'... usually over 2 cm (HVT, arthritis...).
 * Arterial pulsation in the leg:
 * absent often in advanced ICHDK;
 * permanently absent in acute arterial occlusion;
 * many times pulsation cannot be demonstrated in significant swellings.
 * Reflexes:
 * absent/reduced in prolapsed intervertebral discs, other neurological disorders – e.g. radicular sensitivity disorders, paresis, bladder emptying disorders;
 * polyneuropathy (diabetic – characteristically the Achilles tendon reflex is extinguished first, look for disorders of deep sensitivityi – tuning fork – also impaired in peripheral paresis).
 * Sensitivity:
 * acral sensitivity disorders – hosiery in polyneuropathies, especially deep sensitivity is affected;
 * segmental failures – intervertebral disc prolapse, tumors, radiculitis.
 * Starting pain... characteristic of degenerative joint diseases - gonarthrosis, coxarthrosis, osteoporosis.
 * Claudication:
 * typical for ICHDK – calf pain, unilateral/bilateral, dependent on length of walk;
 * spinal canal stenosis – usually both limbs are affected, especially when walking down.
 * Further diagnosis according to the current symptomatology of the disease...== Differential diagnosis ==