Dr. Huntley's
Diagnosis
Checklist
Have a symptom?
See what questions
a doctor would ask.
See what questions
a doctor would ask.
Although leg pain commonly signifies a musculoskeletal disorder, it can also result from a more serious vascular or neurologic disorder. The pain may arise suddenly or gradually and may be localized or affect the entire leg. Constant or intermittent, it may feel dull, burning, sharp, shooting, or tingling. Leg pain may affect locomotion, limiting weight bearing. Severe leg pain that follows cast application for a fracture may signal limb-threatening compartment syndrome. Sudden onset of severe leg pain in a patient with underlying vascular insufficiency may signal acute deterioration, possibly requiring an arterial graft or amputation.
If the patient has acute leg pain and a history of trauma, quickly take his vital signs and determine the leg’s neurovascular status. Observe the patient’s leg position, and check for swelling, gross deformities, or abnormal rotation. Also be sure to check distal pulses and note skin color and temperature. A pale, cool, and pulseless leg may indicate impaired circulation, which may require emergency surgery.
If the patient’s condition permits, ask him when the pain began and have him describe its intensity, character, and pattern. Is the pain worse in the morning, at night, or with movement? If it doesn’t prevent him from walking, must he rely on a crutch or other assistive device? Also ask him about the presence of other signs and symptoms.
Find out if the patient has a history of leg injury or surgery and if he or a family member has a history of joint, vascular, or back problems. Also ask which medications he’s taking and whether they have helped to relieve his leg pain.
Begin the physical examination by watching the patient walk, if his condition permits. Observe how he holds his leg while standing and sitting. Palpate the legs, buttocks, and lower back to determine the extent of pain and tenderness. If a fracture has been ruled out, test the patient’s range of motion (ROM) in the hip and knee. Also, check reflexes with the patient’s leg straightened and raised, noting any action that causes pain. Then compare both legs for symmetry, movement, and active ROM. Additionally, assess sensation and strength. If the patient wears a leg cast, splint, or restrictive dressing, carefully check distal circulation, sensation, and mobility, and stretch his toes to elicit any associated pain.
Continuous deep or boring pain, commonly worse at night, may be the first symptom of bone cancer. Later, skin breakdown and impaired circulation may occur, along with cachexia, fever, and impaired mobility.
Progressive, intense lower leg pain that increases with passive muscle stretching is a cardinal sign of compartment syndrome, a limb-threatening disorder. Restrictive dressings or traction may aggravate the pain, which typically worsens despite analgesic administration. Other findings include muscle weakness and paresthesia, but apparently normal distal circulation. With irreversible muscle ischemia, paralysis and absent pulse also occur.
With a fracture, severe, acute pain accompanies swelling and ecchymosis in the affected leg. Movement produces extreme pain, and the leg may be unable to bear weight. Neurovascular status distal to the fracture may be impaired, causing paresthesia, absent pulse, mottled cyanosis, and cool skin. Deformity, muscle spasms, and bony crepitation may also occur.
Local leg pain, erythema, swelling, streaking, and warmth characterize soft-tissue and bone infections. Fever and tachycardia may be present with other systemic signs. The patient may also experience a loss of function of the affected limb.
With occlusive vascular disease, continuous cramping pain in the legs and feet may worsen with walking, inducing claudication. The patient may report increased pain at night, cold feet, cold intolerance, numbness, and tingling. Examination may reveal ankle and lower leg edema, decreased or absent pulses, and increased capillary refill time.
Patients with sciatica experience shooting, aching, or tingling pain that radiates down the back of the leg along the sciatic nerve. Typically, activity exacerbates the pain and rest relieves it. The patient may limp to avoid exacerbating the pain and may have difficulty moving from a sitting to a standing position.
Acute strain causes sharp, transient pain and rapid swelling, followed by leg tenderness and ecchymosis. Chronic strain produces stiffness, soreness, and generalized leg tenderness several hours after the injury; active and passive motion may be painful or impossible. A sprain causes local pain, especially during joint movement; ecchymosis and, possibly, local swelling and loss of mobility develop.
Discomfort caused by thrombophlebitis may range from calf tenderness to severe pain accompanied by swelling, warmth, and a feeling of heaviness in the affected leg. The patient may also develop fever, chills, malaise, muscle cramps, and a positive Homans’sign. Assessment may reveal superficial veins that are visibly engorged, sensitive to pressure, and palpable, hard, thready, and cordlike.
Mild to severe leg symptoms may develop in patients with varicose veins, including nocturnal cramping; a feeling of heaviness; diffuse, dull aching after prolonged standing or walking; and aching during menses. Assessment may reveal palpable nodules, orthostatic edema, and stasis pigmentation of the calves and ankles.
Localized pain and bleeding arise from infected ulcerations on the lower extremities. Mottled, bluish pigmentation is characteristic, and local edema may occur.
If the patient has acute leg pain, closely monitor his neurovascular status by frequently checking distal pulses and evaluating both legs for temperature, color, and sensation. Also monitor his thigh and calf circumference to evaluate bleeding into tissues from a possible fracture site. Prepare him for X-rays. Use sandbags to immobilize his leg; apply ice and, if needed, skeletal traction. If a fracture isn’t suspected, prepare the patient for laboratory tests to detect an infectious agent or for venography, Doppler ultrasonography, plethysmography, or angiography to determine vascular competency. Withhold food and fluids until the need for surgery has been ruled out. Administer an anticoagulant and antibiotic as needed.
Common pediatric causes of leg pain include fracture, osteomyelitis, and bone cancer. If parents fail to give an adequate explanation for a leg fracture, consider the possibility of child abuse.
If the patient has chronic leg pain, instruct him to take an anti-inflammatory and teach him to perform ROM exercises and, if necessary, to use a cane, walker, or other assistive device. Discuss with the patient and his family any lifestyle changes that may be necessary until leg pain resolves. If physical therapy is necessary, stress the importance of establishing a daily exercise regimen. Based on the cause of the leg pain, discuss the appropriate positioning of the lower extremity to enhance blood flow and venous return.
Read excerpts from these other book chapters related to Leg bruise:
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
|
More About This Book:
Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1 
|
|
What do you think about the features of this website? Take our user survey and have your say:
Next articles:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2010 Health Grades Inc. All rights reserved. Last Update: 9 February, 2010 (1:45)
