Vascular

Patients with predominantly lower extremity limb pain may have underlying vascular disease from thrombosis or vascular claudication. The axillary, calf, and femoral veins are common sites of thrombosis and it is important to take into consideration a history of clotting disorders such as Factor V Leiden, antiphospholipid syndrome, protein C or S deficiencies, and antithrombin III deficiency. Symptoms related to vascular claudication may first be noticed with exercise or prolonged walking and may mimic musculoskeletal diseases or symptoms closely resembling neurogenic claudication from spinal stenosis. The goals of the physical examination should be to establish quality and presence of pulses and to identify the presence of bruits, venous disease, signs of ischemia, or presence of an aneurysm.