Table 1.

Differential Diagnosis for Lower Extremity Pain With or Without Low Back Pain

Diagnosis	Clinical Characteristics
Spinal disorders
Lumbosacral radicular pain secondary to nerve root impingement	Lumbosacral radicular pain (with or without low back pain) in the setting of lumbar disk herniation may be accompanied by a positive straight leg raise test or femoral stretch test
Referred pain from lumbar spine structures (zygapophysial [facet] joints, intervertebral disks)	Low back pain and proximal lower extremity referred pain in nonradicular pattern, usually not below the knee
Lumbar vertebral compression fracture	Low back pain or thoracic pain in an older patient, often of acute onset, with or without specific history of recent injury
Extraspinal disorders
Musculoskeletal diagnoses
Hip joint referred pain	Groin pain, buttock pain, with or without low back pain, or referred symptoms distal to the knee, often with weight bearing; may have limited internal rotation of the hip
Sacroiliac joint referred pain	Low back pain overlying the posterior superior iliac spine, with or without radiating posterior buttock and lower extremity pain
Trochanteric bursitis	Lateral hip and thigh pain, with tenderness over the greater trochanter; low back pain may or may not be present
Piriformis syndrome	Pain localized over the piriformis muscle in the buttocks, with or without radiating posterior buttock and lower extremity pain; tight hip external rotators may be appreciated
Muscle strain or tears	Strains or tears to hip adductors, hip abductors (gluteus medius and minimus), and hip flexors may present with lower extremity pain, with or without low back pain.
Myofascial referred pain	Pain can be reproduced by pressing on tender points or trigger points (eg, gluteus medius and minimus)
Other diagnoses
Intermittent claudication due to peripheral arterial disease	Leg-muscle discomfort, cramping, tightness, or tiredness in the buttock or lower extremity that is induced by exercise, often consistently reproduced after walking a certain distance, relieved rapidly with rest, eased with standing, and not affected by trunk posture12,16; decreased pulses or impaired ankle brachial index may be present
Compartment syndrome	Tightness in the calf after exercise, induced by strenuous exercise, and relieved slowly with limb elevation
Peripheral neuropathy	Pain, numbness, and tingling in the distal lower extremities, particularly the feet and ankles, not substantially affected by posture or exertion
Visceral referred pain	Low back pain, lower extremity pain, or both may be referred from structures in the abdomen and pelvis, including the gastrointestinal tract and genitourinary system