Vascular Pain No Smoking One of the great failings of the physios today is the identification of vascular abnormalities. The reason that we are not instructed in those duties is, in part by the reluctance of medical diagnosis. The practitioner does not treat vascular disease except heart physiotherapy units and therefore is not within its competence. The problem is that sometimes arterial blockages, for example, may be confused with musculoskeletal problems or spinal origin, and SI should know in order to identify derivatives.
I remember one patient with pelvic pain . My treatment was aimed at the lumbar spine or sacro-iliac not remember ... I do remember is that after 3 or 4 sessions without improvement, came one day and said it did not hurt. Had gone to the gynecologist and was diagnosed this pelvic congestion syndrome, and drugs sent to him left him pain. What made me feel bad, it was that had not been able to identify it, (it could happen again) but that even had never heard of it. pain in the pelvic congestion syndrome caused by intrauterine or ovarian varices. Usually bilateral, continuous, heavy feeling, increased with standing, worsening evening and exercise. Improving the posture. Worse in the last days of the cycle and occurs frequently in pregnancy.
All physiotherapists should include these disorders in the differential diagnosis and our clinical reasoning. We try to identify the affected structure and differentiating origin visceral, soft tissue / joint muscle, or neural ... and possibly vascular origin, be forgotten by many.
venous disorders are characterized by a failure of venous return and edema in lower limbs, ecstasy venous (varicose veins), and pulse are normal. The skin is often warmer than normal, of reddish brown or brown by the accumulation of blood in the vessels that increasing pressure results in leakage and hemolysis of red blood cells in the more severe cases. cases are best detected and with which we are most familiar, possibly by the DLM as a therapeutic tool ours, but the arterial disease may spend more unnoticed.
how to identify peripheral arterial disease?
Risk Factors
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hypertension (the major risk factor)
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Smoking (Buerger's disease, which is the most common inflammatory PAD is closely related to the habit smoking , and affects 95% of males under 40 years)
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Hypercholesterolemia
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Diabetes
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Age (prevalence in people over 65 years 8 to 11 times higher)
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Sedentary
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Sex (5 times more common in men)
Inspection .
In peripheral arterial disease (occurring mainly in lower limbs), the pulses are reduced and there are trophic changes in the skin: it is cool to the touch and pale, is drier, smooth, shiny and hairless. Cyanotic nails are strategic or atrophic (thickened and yellowish), and there may be areas of necrosis and ulcers in severe stages.
cold ischemia may occur unilaterally. If symptoms are bilateral and there paresthesia or hyperesthesia, can be confused with neurological problems, but in this case the reflexes are normal.
clinical pattern
The pain appears progressively to walk, is intense, forced to stop walking and goes away with rest (intermittent claudication). Distance march to the one usually constant, and shortens to a slope or up stairs.
Symptoms are always distal to the site of obstruction:
aortic stenosis, common iliac, internal / external = low back pain, buttock and lower limbs
lumbosacral plexus ischemia = sacral pelvic pain and lower limbs and buttocks
= popliteal artery compression calf and foot pain
adductor canal syndrome. Femoral artery occlusion at the canal Hunter (between the adductor magnus and vastus medialis) in the middle third of thigh. The symptoms are pain and numbness in the calf, foot and toes.
Differential Diagnosis
If joint motion is complete, asymptomatic vertebral palpation and without cause referred pain and joint tests are negative, should be suspected vascular pathology. Even with reduced mobility, stiffness, tenderness, or even with positive tests, one can not rule out vascular disease. There are always clinical patterns book.
signs indicative of vascular origin.
The fovea by pressing the nail should disappear immediately. The filling is a snap.
By elevating the limb, it is cold and pale. Flushing time should not exceed 20 seconds
The pressure pain in venous insufficiency will be less with the legs elevated.
pulses in the lower limb may be weaker than in the upper body, but if we compare in the lower limb on one side to the other (if the problem is unilateral), can guide us. Sometimes it is necessary to compare the pulse after a stress test (run 5 minutes, for example, or rely on the time or activity giving rise to symptoms). The pulse absent after a stress test indicates arterial blockage.
The most reliable test is the ankle-brachial index , with a sensitivity of 95% and a specificity of 99%. Divide the systolic blood pressure between the posterior tibial artery systolic blood pressure of the brachial artery. If the result is less than 1 indicates clogged arteries. The measurement is taken with a cuff and a Doppler. Sometimes it is necessary to determine the index after a stress test.
ankle systolic
-------------------- = 1
arm systolic
