A clinical test known as the Homan sign could be performed in which there is a pain in the calf region if there is movement especially of dorsiflexion.(1)
The pain also appears when the calf is squeezed known as Thompson’s test. These signs are also used for a variety of other diseases so they are nonspecific and must be performed carefully.(2)
What Are The First Symptoms Of Popliteal Artery Entrapment Syndrome?
Popliteal artery entrapment syndrome is a rare disorder occurring mostly in healthy adults due to the overuse of the calf muscles. It is mostly associated with sports involving intense activities with legs like athletics, etc. When a person is involved in such sports then the muscles of the body especially the legs respond by increasing the bulk of all the muscle groups.
The calf muscles also hypertrophy in response to the increased usage which may sometimes lead to blocking of calf vessels may it be artery or vein. When there is the involvement of the artery which is the commonest cause among both, it is known as popliteal artery entrapment syndrome. Later on, in the classification of popliteal artery entrapment syndrome, blockage of the vein was also added.
It may present with a variety of symptoms but the most common is intense and excruciating pain. The pain starts early on as in most cases only when there is increased activity and gets automatically resolved with rest. But slowly it starts occurring even in the resting phase due to progressive blockage occurring in the artery. The pain is generated because of the ischemia occurring at the site which is compromised due to loss of blood supply in the popliteal artery and its branches. The tissue supplied by the popliteal artery begins to die as it suffers the loss of necessary nutrients and oxygen.
Other than the pain, symptoms such as coldness of the peripheries like toes, burning, or tingling sensation in the area supplied by the popliteal artery because of damage to the nerves of the supply area. Cyanosis which is more of a sign begins to appear at the end organs especially the toes in later phases of the condition.
How Do You Test For Popliteal Artery Entrapment Syndrome?
Testing of the popliteal artery entrapment syndrome is necessary to diagnose it in the early phase of the condition because it is a very dangerous condition and may lead to a bad prognosis. Clinical examination is to be done thoroughly after the history-taking of the condition has been done. The signs for the blockage of the popliteal artery are to be looked for such as cyanosis, absence of peripheral pulses, gangrenous changes, etc.
Examination of both legs should be done carefully to rule out other causes of pain in the lower leg such as the presence of fracture, tendon rupture, inflammation of any area, peripheral artery disease, etc..(3) Another important test for the diagnosis of popliteal artery entrapment syndrome is the measurement of blood pressure in the lower limb. Blood pressure is measured in both upper and lower limbs and is compared. If there is a decrease in the blood pressure in the lower limb and the ratio of the ankle to brachial blood pressure is decreased, it makes the diagnosis much easier and helps to rule out a variety of other conditions.(4)
Conclusion
Pain is the most common and earliest symptom in almost all cases of popliteal artery entrapment syndrome. It is very less in the early phases of the condition but soon it even occurs at rest and is not relieved by common painkillers.
Thorough clinical examination and history taking are sufficient to diagnose a case of popliteal artery entrapment syndrome and rule out other conditions presenting with similar symptoms.
