Gray J C
Sharp Rees-Stealy, San Diego, Calif., USA.
Phys Ther. 1999 Jun;79(6):582-90.
The purpose of this case report is to illustrate the importance of medical screening to rule out medical problems that may mimic musculoskeletal symptoms.
This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. She also reported numbness in her left leg after walking, sensations of cold and then heat during walking, and cramps in her right calf muscle. She did not report any leg pain. A medical screening questionnaire revealed an extensive family history of heart disease. Examination of the lumbar spine and nervous system was negative. A diminished dorsalis pedis pulse was noted on the left side. Stationary cycling in lumbar flexion reproduced the patient's complaints of lower-extremity weakness and temporarily abolished her dorsalis pedis pulse on the left side.
She was referred back to her physician with a request to rule out vascular disease. The patient was subsequently diagnosed, by a vascular specialist, with a "high-grade circumferential stenosis of the distal-most aorta at its bifurcation."
This case report points out the importance of a thorough history, a medical screening questionnaire, and a comprehensive examination during the evaluation process to rule out medical problems that might mimic musculoskeletal symptoms.
本病例报告旨在说明医学筛查对于排除可能模仿肌肉骨骼症状的医学问题的重要性。
本病例报告描述了一名被诊断为坐骨神经痛但体征和症状与血管狭窄相符的女性。患者主诉双侧下肢无力，疼痛程度在左骶髂关节和左臀部区域为最低水平。她还报告走路后左腿麻木，走路时有冷感然后是热感，以及右小腿肌肉痉挛。她未报告任何腿部疼痛。一份医学筛查问卷显示有广泛的心脏病家族史。腰椎和神经系统检查均为阴性。发现左侧足背动脉搏动减弱。腰椎前屈时进行固定自行车运动重现了患者下肢无力的主诉，并使左侧足背动脉搏动暂时消失。
她被转回给她的医生，要求排除血管疾病。该患者随后被血管专科医生诊断为“最远端主动脉在其分叉处的高度环形狭窄”。
本病例报告指出了在评估过程中进行详尽病史询问、医学筛查问卷以及全面检查以排除可能模仿肌肉骨骼症状的医学问题的重要性。
