Symptoms of peripheral vascular diseases

Symptoms of Peripheral Arterial disease

Blood flow through the arterial system may be reduced gradually or suddenly, in either large or small vessels. This leads to a range of potential presenting symptoms.

Claudication

Claudication is muscle pain that occurs with exercise. It is often cramping in nature and relieved by rest. Once recovered, the patient is able to exercise again for a similar duration before the cramp recurs. It is caused by chronic stenosis or occlusion in the artery feeding the muscle group: for example, calf pain on walking due to superficial femoral artery occlusion.

Rest pain

Pain occurring at rest reflects more severe ischaemia, either chronic or acute. The distal parts of the limb and foot are most affected, unlike claudication which involves the muscle groups in the calf and thigh. Typically rest pain is aggravated by elevation of the limb. Foot pain is therefore worse at night. The patient may wake to hang the foot out of the bed, or get up and walk around until the foot recovers. The pain is severe and often requires strong analgesics to control it.



Color changes of the limb

Acute arterial occlusion leads to a pale 'white' leg because the vessels in the skin contain little blood. These vessels then dilate and fill slowly with de-oxygenated blood producing a 'mottled blue' discoloration. If the occlusion is acute on chronic there will be some collateral supply: the color change may not be so dramatic and may recover to normal.

In chronic ischaemia the foot will become pale when elevated but is often red when dependent due to reactive hyperaemia. These color changes form the basis of Buerger's test for chronic severe ischaemia.

Sensory motor symptoms

With severe ischaemia patients may describe numbness of the foot or toes. Loss of motor function with weakness or paralysis is seen in severe acute ischaemia.

Change in temperature

The ischaemic limb fails to maintain a normal temperature and becomes cold. Patients may take to wearing thick socks and wrapping the feet in blankets. This does help to warm the limb to some extent and can occasionally be misleading.

Symptoms of Venous disease

Pain

The pain associated with venous insufficiency is often an ache on standing that gets worse as the day progresses. Distended varicose veins may be a focus of pain and tenderness. Inflamed thrombosed veins (thrombophlebitis) are acutely painful, red and tender.

Swelling

Oedema from the ankle extending up the leg is a common symptom in patients with worsening venous insufficiency.

Pain and Tingling in the Hand? It can be Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome

This is a kind of entrapment neuropathy, carpal tunnel syndrome is a painful condition caused by pressure on the median nerve stuck between the carpal ligament and other structures inside the carpal tunnel. The contents of the tunnel can be swelled up by organic lesions such as synovitis of the tendon sheaths or carpal joints, recent or not properly healed fractures, tumors, and rarely congenital anomalies. Though there is no structural lesion is evident, flattening or even circumferential compression of the median nerve may be seen during operative section of the ligament. This condition sometimes complicate pregnancy and is found in peoples with a history of recurring use of the hands like knitting sweaters, and may also occur after injuries of the wrists. In certain familial type of carpal tunnel syndrome no etiologic factor can be found.


Symptoms and Signs of Carpal Tunnel Syndrome

Pain, burning, and tingling along the course of the median nerve, which is on the palmer aspect involving thumb, index and half of the middle finger usually the symptoms to start with. Aching pain may spread out to the forearm and even sometimes to the shoulder and over the neck and chest. Pain is often increased by manual exercise, particularly by extreme folding of the wrist in either side. It is most niggling at night. Diminished sensation along the median nerve route may or may not be apparent. Slight inequality between the affected and healthy sides can be demonstrated by asking patient to feel different textures of cloth by thumb and index finger on either side and they can then tell the different feel in two hands. Tinel's sign is tingling or shock-like pain on tapping of the ventral aspect of the wrist. The carpal compression test, where lack of feeling and tingling are produced by the application of direct pressure over the carpal tunnel. Weakness and atrophy of the muscle, particularly of the thenar eminence (adjacent to the thumb on palm), appears late and usually follows sensory disturbances. Electromyography and nerve conduction tests can show precisely the affection of the nerves.

Conditions May Mimic Carpal Tunnel Syndrome

Carpal tunnel syndrome has similarity with other cervicobrachial pain syndromes, from compression syndromes of the median nerve in the forearm or arm, and from mononeuritis multiplex and must be differentiated from these prior to start of specific treatment. When on the left side, it may sometimes be confused with angina pectoris.

Treatment of Carpal Tunnel Syndrome

Treatment of this condition is to release the compression on the median nerve. When a causative factor is found, that is treated. In others, where cause of carpal tunnel syndrome is suspected due to repetitive hand works, should alter their hand actions and their affected wrist is splinted for 2 to 6 weeks. NSAIDs is also prescribed to relieve pain. Corticosteroid injection into the carpal tunnel or operation is required in case of non improvement and when there is thenar muscle atrophy or weakness. Muscle strength is regained following the treatment, but complete recovery may not be possible when there is extreme atrophy.