heart and blood vessel disorders
Limb Pain
Evaluation of Limb Pain
It is particularly important to make sure the person does not have a sudden blockage of an artery because the limb can develop gangrene if there is no blood flow for more than a few hours. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with limb pain, certain symptoms and characteristics are cause for concern. They include Sudden, severe pain Limb that is cold to the touch or pale Chest pain, sweating, shortness of breath, or palpitations Signs of severe illness (for example, confusion, fever, or collapse) Limb that is suddenly swollen, blistered, or has black spots Risk factors for deep vein thrombosis, such as recent surgery, bed rest, or a cast on a leg New nerve deficits, such as weakness or numbness of the affected limb People who have warning signs should see a doctor right away. People without warning signs should call a doctor. The doctor will decide how quickly the person needs to be seen based on the symptoms, age, and presence of other medical disorders. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the limb pain and the tests that may need to be done. Doctors ask How long limb pain has been present Whether pain occurs at certain times or during specific activities How intense the pain is Whether the pain is sharp or throbbing Where the pain is located What activities trigger or worsen pain What the person does to relieve pain What other symptoms (such as numbness or tingling) occur along with the pain Doctors look for symptoms that may indicate a cause of the pain. Some obvious findings may be very helpful in diagnosing the cause of limb pain. For example, back or neck pain suggests that a nerve root may be affected and fever suggests that the person has an infection. Shortness of breath and a rapid heart rate suggest blockage of an artery by a blood clot that has traveled from a leg to the lungs ( ). An irregular pulse suggests that the person may have a certain abnormal heart rhythm ( The painful limb is inspected for color, swelling, and any skin or hair changes. The doctor also checks for pulses, temperature, tenderness, and crepitation (a subtle crackling sensation indicating gas in the soft tissue caused by a serious infection). Strength, sensation, and reflexes are compared between affected and unaffected sides. Blood pressure is sometimes measured in the ankle or wrist of the affected limb and compared with the blood pressure in an unaffected arm or leg. If blood pressure is much lower in the painful limb, it is likely that the arteries in the limb are blocked. Testing is not needed for all people with limb pain. Doctors can often diagnose some causes of limb pain based on the people's symptoms and the physical examination findings. However, testing is needed in some cases to confirm the diagnosis. For example, doctors may check the ankle-brachial index to diagnose Occlusive Peripheral Arterial Disease .The blood pressure is measured in both arms and both legs. If blood pressure in the ankle is lower than that in the arms by a certain amount (less than 90% of arm pressure), blood flow to the leg is inadequate. 