A patient with spinal stenosis in the lumbar or sacral spine may develop symptoms that may mimic vascular claudication.
Mechanism: degenerative arthritis with compression of nerve roots
Symptoms may include:
(1) pain that radiates into the lower extremity and may be worse above the knees
(2) pain is exacerbated by walking, standing straight or when in certain postures
(3) pain is relieved with sitting, lying down, flexion at the waist or when inactive
(4) positive shopping cart sign (pain relieved using a shopping cart)
(5) weakness or cramping in the legs
(6) numbness and/or paresthesias in the legs
Symptoms are usually bilateral but may be asymmetrical.
The neurological exam may be normal or may show:
(1) muscle weakness
(2) absent deep tendon reflexes (DTR)
(3) sensory loss
Features of vascular claudication:
(1) pain worse in the calves (below the knees)
(2) pain relieved by standing
