Limping patient

Diagnosis

 * Skin color and temperature:
 * pinkish and cold (arterial circulatory disorders);
 * red and hot skin (deep venous thrombosis = DVT);
 * red stripe (thromboflebitis);
 * red swollen joints (arthritis uratica, rheumatoid arthritis, rheumatoid fever).
 * Differences in calf circumference...usually more than 2 cm (DVT, arthritis....).
 * Arterial pulsation in the leg:
 * usually absent in advanced lower limb ischemia;
 * permanently absent in acute arterial occlusion;
 * often cannot be found because of edema.
 * Reflexes:
 * absent/reduced in intervertebral disc prolapse, other neurological disorders – for example radicular sensitivity disorders, paresis, urinary bladder emptying disorders;
 * polyneuropathy (diabetic – first the Achilles tendon reflex is reduced, we should look for deep sensitivity disorders – tuner – also disrupted in peripheral paresis).
 * Sensitivity:
 * acral sensitivity disorders – "stocking-glove pattern" in polyneuropathies, deep sensitivity disrupted;
 * segmental loss of sensitivity – intervertebral disc prolapse, tumors, radiculitis.
 * Start pain (the pain occurs when the patient starts to walk)... characteristic in degenerative joint diseases – gonarthrosis, coxarthrosis, osteoporosis.
 * Claudication:
 * typical for lower limb ischemia – calf pain, one side/both sides, depends on the length of the walk;
 * spinal canal stenosis – usually both limbs are affected, especially while walking down.


 * Other diagnosis depend on current symptoms...