The following signs and symptoms are associated with peripheral arterial disorders.

Diminished or Absent Peripheral Pulses

The more occluded or restricted the arterial blood flow and the more diminished the peripheral pulses, the more severe or advanced is the arterial disease. If the collateral circulation is extensive, the patient may not experience pain despite diminished pulses.

Integumentary Changes

A number of integumentary changes are associated with peripheral arterial disease.

· Skin discoloration, including pallor at rest or with exercise, or reactive hyperemia can develop. Pallor is more evident when the extremity is elevated above the level of the heart for several minutes. Reactive hyperemia occurs when the extremity is moved from an elevated to a dependent position. The skin takes on a bright red appearance rather than a normal pink flush. (Refer to the test for rubor of dependency in the following section.) Pallor of the distal extremity may also occur with exercise. After exercise, cutaneous ischemia causes blanching of the skin as arterial blood flow is diverted to the exercising muscles and away from the surface tissues of the distal extremity.

· Trophic changes include a shiny, waxy appearance and dryness of the skin and loss of hair distal to the occlusion.

· Skin temperature is decreased.

· Ulcerations may develop, particularly at weight-bearing areas or over bony prominences.

Sensory Disturbances

Intolerance to heat or cold and paresthesia (initially tingling, then numbness) can develop.

Exercise Pain and Rest Pain

Pain during exercise and at rest is associated with progressive peripheral arterial disease and leads to significant disability.

Exercise pain. Pain that occurs and gradually increases with exercise is referred to as intermittent claudication. It is experienced most common in the lower extremities and occurs more frequently and with greater intensity as the severity of chronic arterial insufficiency progresses. During the early stages of arterial disease, intermittent claudication is characterized by a feeling of fatigue or weakness and, later, as cramping or aching in the muscles used during exercise.

Pain is located distal to the occluded vessels and is caused by insufficient blood supply and activity-induced ischemia in the exercising muscles. Leg pain typically is brought on by walking and gradually subsides when the patient stops walking. Intermittent claudication does not occur with extended periods of standing (as seen with spinal stenosis) or with prolonged sitting (as seen with sciatica).

Although exercise pain is most common in the calf, it also can occur more proximally. identifies common sites of intermittent claudication.

If peripheral vessels such as the popliteal, femoral, or iliac arteries are occluded, symptoms usually occur in one extremity; whereas if the occlusion is in the lower aorta, symptoms are present not only in both extremities but in the buttocks and low back regions as well. As the disease progresses and arterial insufficiency increases, exercise tolerance deteriorates as ischemic pain occurs more readily with activity.

Rest pain. When a burning, tingling sensation gradually becomes evident in the distal extremities at rest or with elevation, it may be indicative of severe ischemia. With ischemia, pain frequently occurs at night because the heart rate and volume of blood flow to the extremities decreases with rest. Sometimes partial or complete relief of pain is possible if the leg is placed in a dependent position, such as over the edge of a bed. In contrast, elevation of the limb increases the pain.

Muscle Weakness

Loss of strength, muscle atrophy, and eventual loss of motor function, particularly in the hands and feet, occur with progressive arterial vascular disease. Loss of motor function is compounded by pain, which further compromises functional strength.

Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

Related Articles