Differences between vascular and neurogenic claudication are a must know for exams.
Claudication comes from latin word claudicare which means “limp”.
Vascular claudication is the discomfort that comes from a vascular cause. On the other hand, neurogenic type is due to compression of nerve root or spinal cord.
Here, we enumerate these 15 differences
1. Site of pain: In vascular claudication, calf is the main site of pain. On the other hand, neurogenic claudication affects leg, buttocks and thigh.
2. The direction in vascular type is from distal to proximal. on the contrary, the direction of pain in neurogenic type is from proximal to distal.
3. Character of pain: Cramping pain is the feature of vascular claudication. Numbness and ache indicate neurogenic.
4. Relief of pain occurs by both sitting and standing in vascular type. In neurogenic claudication, you must stoop, forward flex or lie to get pain relief.
5. Vascular examination, in fact, be abnormal in vascular claudication. It may be normal in neurogenic.
6. Walking distance is fixed in vascular type but variable in neurogenic one.
7. Weakness is a feature of neurogenic claudication. However, it is rare in vascular type
8. Walking uphill is painful in vascular type but less painful in neurogenic.
Activities that involve flexion of the lumbar spine i.e. bending forward flexes the lumbar spine, thus reducing the lumbar lordosis. Hence, it increases the space available for the cauda equina within the spinal canal, leading to improvement of symptoms.
This forms the basis of shopping cart sign becoming positive in vascular type but negative in the other.
Other differences between vascular and neurogenic claudication
9. On the other hand, walking downhill is painless in vascular type and painful in the other.
10. Bicycle test is positive in vascular but negative in neurogenic type
11. Back pain is an inherent feature of neurogenic claudication. However, may be rare finding in vascular.
12. Similarly, back motion is in limit in neurogenic claudication. You may now be able to discern this cause.
13. Atrophy, on the other hand, is a feature of vascular type.
14. Skin may be shiny with loss of hair in vascular claudication. The cause is obvious. On the other hand, it may be normal in the second type.
15. Pulses, may be absent or less in vascular type. However, this feature may not be present in other.
Tabulating the differences between vascular and neurogenic claudication.
| S.N. | Differences | Vascular | Neurogenic |
| 1 | Pain | Calf | Leg / buttock/ thigh |
| 2 | Direction | Distal to proximal | Proximal to distal |
| 3 | Character | Cramping | Numbness, aching |
| 4 | Relief | Both sitting and standing. Usually takes 5 minutes | forward flexion, stooping or lying. Takes 20 minutes. |
| 5 | Vascular examination | Abnormal | Normal |
| 6 | Walking distance | Fixed | Variable |
| 7 | Weakness | Rare | Occasional |
| 8 | Walking uphill | Painful | Painless |
| 9 | Walking Downhill | Painless | Painful |
| 10 | Bicycle test | Positive | Negative |
| 11 | Back pain | Occasional | Common |
| 12 | Back motion | Normal | Limited |
| 13 | Atrophy | Uncommon | Occasional |
| 14 | Skin | Loss of hair; shiny | Normal |
| 15 | Pulses | Absent / diminished | Normal |
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