Exertional leg pain: teasing out arterial entrapments.
Vascular causes of exertional lower extremity pain are relatively rare, but may be the answer in athletes refractory to treatment for the more common overuse syndromes of the lower extremities. It is important to differentiate these vascular causes from chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), and stress fractures in order to develop appropriate treatment plans, avoid complications, and return athletes to play expeditiously. Important vascular etiologies to be considered are popliteal artery entrapment syndrome (PAES), endofibrotic disease, popliteal artery aneurysm, cystic adventitial disease, and peripheral arterial dissections. The diagnostic workup involves angiography or noninvasive vascular studies such as Doppler ultrasound or magnetic resonance angiography in both the neutral and provocative positions. Treatment of these vascular abnormalities typically involves surgical correction of the vascular anomaly.
Pham
Thomas T
TT
Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA 19107, USA.
Kapur
Rahul
R
Harwood
Marc I
MI
D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000601:surgery; D001265:Athletic Injuries / Q000175:diagnosis* / Q000601:surgery; D012090:Cumulative Trauma Disorders / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000209:etiology*; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000601:surgery; D018608:Ultrasonography, Doppler