Template:Lower Limb Pain Neurogenic and Referred DDX

• Systemic Conditions
  • Metabolic Neuropathy
    • Diabetes Mellitus with distal symmetrical polyneuropathy
    • Diabetes Mellitus of other subtypes - proximal diabetes, truncal, cranial, median and ulnar neuropathies
    • Diabetes Mellitus with autonomic neuropathy
    • Diabetic amyotrophy Probably a vasculitis aetiology with ischaemia followed by axonal degeneration and demyelination. Characterised by unilateral weakness, wasting, and pain, commonly in the quadriceps, then spreading later to the contralateral side asymmetrically.
  • Vasculitic Neuropathy vasculitis of the small and medium-sized vessels in the peripheral nervous system.
    • Primary vasculitides: Churg-Strauss syndrome, microscopic polyangiitis, classic polyarteritis nodosa and Wegener granulomatosis
    • Secondary vasculitides: A complication of connective tissue disease (systemic lupus erythematosus, rheumatoid arthritis and Sjögren syndrome), infection (hepatitis B and C, human immunodeficiency virus, Lyme disease, cytomegalovirus, Herpes zoster virus and various bacterial infections), medication (sulphonamides, other antibiotics and anti-viral agents) and paraneoplastic vasculitis
  • Paraneoplastic peripheral neuropathy In addition to local effects and paraneoplastic vasculitis, can also get sensorimotor paraneoplastic neuropathy. May have anti-neuronal antibodies and EMG findings.
• Brain
  • Multiple sclerosis
  • Parkinson’s disease
  • Motor neurone disease
  • Post-stroke pain in lenticulo-capsular haemorrhages
  • Space-occupying lesions.
• Spinal Cord
  • Multiple sclerosis
  • Motor neurone disease
  • Syringomyelia
  • Transverse myelitis
  • Posterior or anterolateral situated space-occupying lesion (e.g. disc herniation, tumour, abscess, haematoma)
• Cervical and Thoracic Spinal Canal
  • Any posterior or anterolateral space-occupying lesion (e.g. abscess, tumour, haematoma)
• Conus Medullaris
  • Disc pathology
  • Tumours (soft tissue, intradural, extradural, bone, metastases)
• Lumbar Spine Canal
  • Interspinous bursa (kissing spines, Baastrup's disease)
  • Facet joint (OA, hypertrophy, cyst, rotational instability)
  • Anterolisthesis or retrolisthesis
  • Space-occupying lesion (disc pathology, haematoma, tumours)
• Lumbar Nerve Root Canal
• Lumbar Extraforaminal Area
• Pelvis
  • L5 transitional vertebra pseudoarthrosis with a large osteophyte compressing L5 nerve root
  • Lumbosacral ligament ossification in combination with inferior L5 vertebral body osteophytes impinging L5 nerve root
  • Stress fracture of sacrum or pubic rami
  • Degenerative sacroiliitis with an osteophyte extending anteriorly compressing a nerve root
  • Sacroiliitis of any type
  • Tumours of bone and soft tissue
  • Lumbosacral radiculoplexus neuropathy presents with asymmetrical lower limb pain, weakness, atrophy and paraesthesia. It can be caused by diabetic lumbosacral</br>radiculoplexus neuropathy, non-diabetic lumbosacral radiculoplexus neuropathy, chronic inflammatory demyelinating polyneuropathy, connective tissue disease, Lyme disease, sarcoidosis, HIV and cytomegalovirusrelated polyradiculopathy.
  • Piriformis muscle syndrome with compression of ischiadic nerve
  • Superior gluteal nerve entrapment syndrome The clinical diagnosis triad of buttock pain, weakness of hip, abduction and marked tenderness on deep palpation in the region just lateral to the greater schiadic notch
• Lower Extremity