Claudication pain -Peripheral Occlusive Vascular Disease

Peripheral Occlusive Vascular Disease

Characteristic features of Claudication pain

1.     Claudication pain is always precipitated by activity

2.     Claudication pain t is relieved by taking rest

3.     Claudication painis a cramp like pain felt over the muscles

4.     Claudication pain is always reproducible

Congenital Disease associated with Claudication pain is Coarctation of Aorta. Hence in a child with Claudication pain of the lower limbs suspect this condition.

Importance of Site of Claudication pain

Site of Claudication pain is an indicator of the site of arterial occlusion;

Gluteal region if the occlusion is at the level of Iliac Arteries.

Thigh region if the occlusion is at the level of Femoral Arteries.

Calf region if the occlusion is at the level of Popliteal  Arteries.

In the Foot region if the occlusion is at the level of Tibial Arteries

Claudication Distance

Claudication Distance is the distance travelled by a person with Peripheral Occlusive Vascular Disease before the onset of Pain.

It is thought to be due to the accumulation of Substance P.

Factors Affecting Claudication Distance

Claudication Distance Decreases when-

•    There is increased Speed of walking- 

•    Resistance offered for walking- ie  walking against wind 
•    Walking up hill

•    Poor General Health of the patient 

•    Systemic diseases of the patient

Boyd’s Classification of Claudication Pain

Grade I –Patient develops pain on walking. But  if he continues to walk, the pain disappears. This is due to the washing away of the Substance P

Grade I I–Patient develops pain on walking. But  if he continues to walk, the pain persists. But the patient can still walk with some efforts.

Grade I I I–Patient develops pain on walking. The pain compels the patient to take rest.

Rest Pain

Rest Pain is the pain felt even at rest. It is due to the Ischemia of the somatic nerves.

Hence the Rest Pain is known as the Cry of the dying nerve.

Rest Pain is more when the limb is kept in the Horizontal position. When the limb is kept in hanging down position the pain gets relieved as the gravity aids in the blood flow to the nerves.