Chronic Leg Pain

A 52-year-old man, on long-term steroids for asthma, presented to neurologists in mid-1993 with a 5-month history of bilateral shin pain. It increased throughout the day, especially on standing and eased at rest. They noted a patch of decreased sensation to pin-prick, temperature and light touch in the left L5 distribution, but electromyography and computed tomography of the lumbar spine showed no nerve impingement. He was investigated by a rheumatology team in October 1993, and because of a previous history of sarcoid lung disease, an isotope bone scan was arranged, which was normal. He was seen by an orthopaedic team in 1994 and magnetic resonance imaging showed "moderate sized L5/S 1 disc protrusion, not clinically significant with no evidence of spinal stenosis". Concurrently, he was also investigated by a vascular team; Dop-pler studies of both limbs were normal, but unfortunately he did not attend a transfemoral angiogram to exclude aorto-iliac disease. He remained symptomatic and was seen by the vascular team again whilst in hospital for respiratory problems in January 1996. Examination revealed a tender anterior compartment and Duplex studies showed the muscles in the involved compartment * sensory deficit to light touch, pin-prick, 2-point discrimination in the distal sensory distribution *