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Claudication, literally 'limping' (Latin), is a medical term usually referring to impairment in walking, or pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest.^[1]^[2] The perceived level of pain from claudication can be mild to extremely severe. Claudication is most common in the calves but it can also affect the feet, thighs, hips, buttocks, or arms.^[1] The word "claudication" comes from the Latin "claudicare" meaning to limp.

Claudication that appears after a short amount of walking may sometimes be described by US medical professionals by the number of typical city street blocks the patient can walk before the onset of claudication. Thus, "one-block claudication" refers to claudication that appears after walking one block, "two-block claudication" appears after walking two blocks, etc.

Types

Intermittent vascular

Intermittent vascular (or arterial) claudication (Latin: claudicatio intermittens) most often refers to cramping pains in the buttock or leg muscles. It is caused by poor circulation of the blood to the affected area, called Peripheral artery disease. The poor blood flow is often a result of atherosclerotic blockages more proximal to the affected area;^[3] individuals with intermittent claudication may have diabetes—often undiagnosed.^[4]

Spinal or neurogenic

Spinal or neurogenic claudication is not due to lack of blood supply, but rather it is caused by nerve root compression or stenosis of the spinal canal,^[5] usually from a degenerative spine, most often at the "L4-L5" or "L5-S1" level. This may result from many factors, including bulging disc, herniated disc or fragments from previously herniated discs (post-operative), scar tissue from previous surgeries, osteophytes (bone spurs that jut out from the edge of a vertebra into the foramen, the opening through which the nerve root passes). In most cases neurogenic claudication is bilateral, i.e. Symmetrical .

Jaw

Jaw claudication is pain in the jaw or ear while chewing. This is caused by insufficiency of the arteries supplying the jaw muscles, associated with giant cell arteritis.^[6]^[7]

Differential diagnosis

Vascular (or arterial) claudication typically occurs after activity or ambulation for a distance with resultant vascular insufficiency (lack of blood flow) where the muscular demands of oxygen outweighs the supply. Symptoms are lower extremity cramping. Resting from activity even in a standing position may help relieve the symptoms. Spinal or neurogenic claudication may be differentiated from arterial claudication based on activity and position. In neurogenic claudication, positional changes lead to increased stenosis (narrowing) of the spinal canal and compression of nerve roots and resultant lower extremity symptoms. Standing and extension of the spine narrows the spinal canal diameter. Sitting and flexion of the spine increases spinal canal diameter. A person with neurogenic claudication will have worsening of leg cramping with standing erect or standing and walking. Symptoms may be relieved by sitting down (flexing the spine) or even by walking while leaning over (flexion of the spine) a shopping cart.^[4]

The ability to ride a stationary bike for a prolonged period of time differentiates neurogenic claudication from vascular claudication. Weakness is also a prominent feature of spinal claudication that is not usually present in intermittent claudication.^[4]

Prognosis

The prognosis for patients with peripheral vascular disease due to atherosclerosis is poor; patients with intermittent claudication due to atherosclerosis are at increased risk of death from cardiovascular disease (e.g. heart attack), because the same disease that affects the legs is often present in the arteries of the heart.^[8]

Treatment

Blocking agents of the adrenoceptors alpha 1/alpha 2 are typically used to treat the effects of the vasoconstriction associated with claudication. Cilostazol (trade name: Pletal) is FDA approved for intermittent claudication. It is contraindicated in patient with heart failure, and improvement of symptoms may not be evident for two to three weeks.

References

^ ^a ^b Peripheral Arterial Disease at Merck Manual of Diagnosis and Therapy Professional Edition
^ "claudication" at Dorland's Medical Dictionary
^ Simon RW, Simon-Schulthess A, Simon-Schulthess A, Amann-Vesti BR (April 2007). "Intermittent claudication". BMJ 334 (7596): 746. doi:10.1136/bmj.39036.624306.68. PMC 1847882. PMID 17413176.
^ ^a ^b ^c Burns P, Gough S, Bradbury AW (March 2003). "Management of peripheral arterial disease in primary care". BMJ 326 (7389): 584–8. doi:10.1136/bmj.326.7389.584. PMC 1125476. PMID 12637405.
^ Comer CM, Redmond AC, Bird HA, Conaghan PG (2009). "Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists". BMC Musculoskelet Disord 10: 121. doi:10.1186/1471-2474-10-121. PMC 2762954. PMID 19796387.
^ Reiter S, Winocur E, Goldsmith C, Emodi-Perlman A, Gorsky M (2009). "Giant cell arteritis misdiagnosed as temporomandibular disorder: a case report and review of the literature". J Orofac Pain 23 (4): 360–5. PMID 19888487.
^ Rieck KL, Kermani TA, Thomsen KM, Harmsen WS, Karban MJ, Warrington KJ (July 2010). "Evaluation for Clinical Predictors of Positive Temporal Artery Biopsy in Giant Cell Arteritis". J Oral Maxillofac Surg 69 (1): 36–40. doi:10.1016/j.joms.2010.02.027. PMID 20674120.
^ Shammas NW (2007). "Epidemiology, classification, and modifiable risk factors of peripheral arterial disease". Vasc Health Risk Manag 3 (2): 229–34. doi:10.2147/vhrm.2007.3.2.229. PMC 1994028. PMID 17580733.

UpToDate Contents

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1. 下肢末梢動脈疾患の臨床的特徴および診断 clinical features and diagnosis of lower extremity peripheral artery disease
2. 跛行のマネージメント management of claudication
3. Investigational therapies for treating symptoms of lower extremity peripheral artery disease
4. 末梢動脈疾患（PAD）の疫学、危険因子、および自然経過 epidemiology risk factors and natural history of peripheral artery disease
5. 下肢跛行患者の手術の適応 indications for surgery in the patient with lower extremity claudication

English Journal

Evaluation of the clinical relevance and limitations of current pre-clinical models of peripheral artery disease.

Krishna SM1, Omer SM1, Golledge J2.
Clinical science (London, England : 1979).Clin Sci (Lond).2016 Feb 1;130(3):127-50. doi: 10.1042/CS20150435.
Peripheral arterial disease (PAD) usually results from atherosclerosis and associated thrombosis and limits blood supply to the lower limbs. Common presenting symptoms include intermittent claudication (IC), rest pain and tissue loss. When limb viability is threatened, known as critical limb ischaem
PMID 26678170

Contemporary Outcomes for Open Infrainguinal Bypass in the Endovascular Era.

Reifsnyder T1, Arhuidese IJ1, Hicks CW1, Obeid T1, Massada KE2, Khaled A3, Qazi U1, Malas MB4.
Annals of vascular surgery.Ann Vasc Surg.2016 Jan;30:52-8. doi: 10.1016/j.avsg.2015.10.003. Epub 2015 Nov 6.
BACKGROUND: The role of infrainguinal bypasses in this era of increasing endovascular interventions remains the subject of significant debate. In this study, we evaluate contemporary long-term outcomes of lower-extremity open revascularization for peripheral arterial disease (PAD).METHODS: We evalua
PMID 26549809

The Epidemiologic and Clinical Findings of Patients with Buerger Disease.

Igari K1, Inoue Y2, Iwai T3.
Annals of vascular surgery.Ann Vasc Surg.2016 Jan;30:263-9. doi: 10.1016/j.avsg.2015.07.014. Epub 2015 Sep 11.
BACKGROUND: Buerger disease is a nonatherosclerotic peripheral arterial disease, which is mostly observed in young male smokers. Buerger disease is characterized by the observation of peripheral arterial occlusion by angiography. The condition may be caused by microembolization in the small-sized ar
PMID 26370744

Japanese Journal

巨細胞性動脈炎 (特集新たな指定難病としての膠原病関連疾患)

臨床免疫・アレルギー科 = Clinical immunology & allergology 65(1), 1-5, 2016-01
NAID 40020719642

Angio-Seal® に起因した大腿動脈狭窄性病変に対して血栓内膜摘除術を施行した1例

日本心臓血管外科学会雑誌 45(1), 62-66, 2016
NAID 130005124811

Acute Myeloid Leukemia Complicated by Giant Cell Arteritis

Internal Medicine 55(3), 289-293, 2016
NAID 130005122594

Related Pictures

★リンクテーブル★

リンク元	「間欠性跛行」「跛行」「limping」
拡張検索	「arteriosclerotic intermittent claudication」

「間欠性跛行」

Claudication
Classification and external resources
Specialty	Neurology, rheumatology, vascular surgery
ICD-10	I73.9
ICD-9-CM	443.9
DiseasesDB	2777
MeSH	D007383

　　[★]

intermittent claudication
英: intermittent claudication
同: 間欠跛行, 間欠性跛行症; 血管硬化性間欠性歩行困難症 arteriosclerotic intermittent claudication
関: 歩行

[show details]

間欠跛行 : 約 8,570 件
間欠性跛行 : 約 16,100 件

定義

ある一定の距離を歩くと歩行困難となり、休息により回復するが、再び歩き続けると同様の現象が生じ歩行持続困難となるというエピソードを繰り返すもの。
ある距離を歩くと下肢の筋組織に生じる痛みのために、歩行をつづけることができなくなり、しばらく休息すると疼痛が消失して歩行可能となるが、また歩行すると同様の症状が出現する病態を間欠性跛行という。

分類

動脈性

原因：下肢の虚血性筋痛と筋力低下

閉塞性動脈硬化症 arteriosclerosis obliterans ASO

バージャー病 thromboangitis oblitrans TAO

Leriche症候群

馬尾性

原因：馬尾神経圧迫

腰部脊柱管狭窄症：下肢の異常感覚や疼痛の拡大・増悪と筋力低下。増悪：立位、腰椎伸展位。軽快：坐位、腰椎屈曲位

脊髄性

原因：脊髄虚血

脊髄動静脈奇形

症状

ある一定時間歩くと両下肢の傷み、重苦しさ、しびれなどが増強する。
休憩することで軽快するが、歩行によりこれらの症状が再発する。

鑑別

	ASO	L-SCS
発生部位	腓腹部	大腿後面、下腿外側
症状変動	あまりない	変動有り
改善	急速で速やかに改善たったままで治る	時間がかかる座位(前屈)で軽減
頻度	少	多