Case of the Month #21: Spinal Stenosis by Dr Helen Laycock
Other lower limb painful conditions such as peripheral artery disease (ischaemic claudication), hip osteoarthritis and greater trochanteric pain syndrome. Typically, vascular claudication is not exacerbated by standing or relieved by forward flexion, and examination of pulses alongside an abnormal ankle-brachial index can exclude this diagnosis. Location of pain can often exclude hip osteoarthritis (pain mostly in the groin, anterior thigh or buttock exacerbated by internal rotation of flexed hip or weight bearing) and greater trochanteric pain (tenderness directly over the trochanteric bursa). Cauda equina syndrome is more likely to present as rapidly progressive urinary retention, faecal incontinence, numbness of genital, rectal and perineal regions and lower extremity muscle weakness. This requires prompt referral.