An 85-year-old gentleman complaint of pain in leg while lying down, it lessens when he hangs the foot out of bed. What is the cause?
**Core Concept:**
The patient presents with a clinical sign called "Charley Horse" or "Straight Leg Raise Test," which is a common phenomenon seen in subjects with lower limb muscle cramps. This test involves raising the leg while observing if it results in pain in the patient. The pain in the leg while lying down and its relief when the foot is hung out of the bed indicates the presence of a cramp.
**Why the Correct Answer is Right:**
The correct answer is **Correct Answer:** D. Sciatica. Sciatica is a pain syndrome caused by irritation or compression of the sciatic nerve. When the patient lies down, the sciatic nerve is compressed by the intervertebral foramina, causing pain in the leg. When the patient hangs the foot out of the bed, the pressure on the nerve decreases, alleviating the pain.
**Why Each Wrong Option is Incorrect:**
A. This option refers to "Renal colic", which is a painful medical emergency caused by kidney stones. The patient's symptoms are not consistent with renal colic, as they involve only one leg and do not resolve by hanging the foot out.
B. This option is incorrect as it discusses "Musculoskeletal disorders", which are different from neurological disorders like sciatica. The patient's symptoms do not match musculoskeletal problems like muscle strains or sprains.
C. This option mentions "Postural hypotension", which is a decrease in blood pressure when standing up due to decreased blood volume or reduced blood pressure-regulating mechanisms. The patient's symptoms are unrelated to postural hypotension and do not resolve by hanging the foot out.
**Clinical Pearl:**
Charley Horse is a common clinical presentation that physicians should consider when examining patients with lower limb pain. By understanding the mechanism of pain relief with hanging the foot out, physicians can accurately diagnose sciatica and provide appropriate treatment.