Concomitant Peripheral Artery Disease and Musculoskeletal Pain in Orthopedic Patients

Purpose: Symptoms of peripheral artery disease (PAD) may mimic or present concomitantly with orthopedic or neurologic conditions. These three different fields of conditions may present similarly in the clinic, and thus differentiating them is necessary to avoid the use of unnecessary diagnostic laboratory tests and imaging and to steer clear of faulty diagnoses. This is especially important in the primary care setting, where patients initially present with particular complaints and may need referral for appropriate care.

Materials and Methods: A detailed review of the literature was performed using PubMed.

Results: Past research by Heidrich and Hermann showed that patients with higher stages of Fontaine’s staging for PAD had higher rates of concomitant orthopedic conditions or neurologic conditions. For example, for patients with Fontaine’s stage IV, 42.1% had peripheral polyneuropathies, whereas only 14% had peripheral neuropathies in those with Fontaine’s stage II PAD. Furthermore, Bernstein et al. showed that 20% of patients who presented with degenerative joint disease to an orthopedic clinic had concomitant occult PAD, as determined by noninvasive testing. Another large-scale study by Heidrich showed that not only did 21.6% of patients with PAD have orthopedic disease, but also 60.4% of PAD patients had endocrine or metabolic disease, 16.9% had urologic disease, and 14.8% had gastrointestinal disease.

Conclusions: Multiple vascular, orthopedic, and neurologic pathologies likely contribute to patients’ lower extremity pain. An increased awareness of surgeons to the high likelihood that multiple conditions are present simultaneously is likely to reduce health care expenditures, improve patient satisfaction, and improve long-term outcomes in patients with lower extremity pain. Even in patients who are not presenting with the classical signs of PAD, orthopedic surgeons and primary care physicians should consider examining for PAD. PAD that is concomitant with other musculoskeletal conditions may lead to worse postoperative outcomes, such as disturbed wound healing as evidenced in the ABI-PRIORY trial. Further studies are needed to investigate the potential benefits of increased interdisciplinary management for lower extremity pain and to examine which diagnostic imaging or laboratory modalities are best suited for concomitantly ruling out other non-PAD conditions causing lower extremity pain.