Which of the following is NOT TRUE about intermittent claudication?
Relieve of symptoms is not dependant upon sitting or other positional changes. Intermittent claudication: It refers to the pain or fatigue in muscles of the lower limb caused by walking and relieved by rest. Claudication is derived from the latin word for "liping, lame", strictly speaking, the term should be used only for symptoms in the lower extremities. The pain is a deep seated ache usually in the calf muscle, which gradually progressive until the patient is compelled to stop walking. Patient occasionally describe "cramping"or "tiredness"in the muscle. Typically, symptoms are completely relieved after 2-5 min of inactivity. Claudication is distinguished from other types of pain in lower extremity in that some exeion is always required before it appears; it is reproducible; it does not occur at rest; and it is relieved by cessation of walking. Relieve of symptoms is not dependant upon sitting or other positional changes. The distance a patient can walk varies with the rate of walking, the level of incline, and the degree of aerial obstruction. The average patient with involvement of a single aerial segment can walk 90-180 meters on a level terrain at a moderate pace before pain appears. Regardless of which aerial segment is involved, claudication most commonly involves the calf muscles due to their high workload with normal walking. The correct diagnosis should be easily established by determining the location of pain (calf), the quality of the pain, the length of the time required for relief of symptoms, the reproducibility of symptoms, the distance walked before symptoms begin (initial claudication distance), and the type of rest or position required for relief of symptoms. Although most patients with the disorder do not develop gangrene or require amputations, adverse outcomes of systemic atherosclerosis, including death are common. There is increasing interests in the use of the ankle- brachial index ( ABI ). Normal is >1. Claudication are in the 0.6- 0.9 range. with the rest pain and gangrene occurring at rest <0.3. Indications for surgery include disabling claudication (severely limiting work or lifestyle), rest pain, limb threatening ischemia, and microembolization of the toes in which no other source is identified. Claudication distance will vary from day to day and will altered by walking up hill, and speed of walking of against the wind. Characteristically this pain is worse at night and is worsened by elevation of the extremity, whereas it is somewhat relieved by hanging the foot out of the bed or by sleeping in a chair. Tis rest pain is mainly due to ischemic changes in the somatic nerves, so it is the cry of the dying nerves. Ref: L & B 25/e, page 899 ; Textbook of Surgery By S. Das 5/e, page 151
Most common in calf muscle
Pain is positional
Atherosclerosis is impoant predisposing factor
Relieved by rest