Bicycle Test of Van Gelderen
Introduction[edit | edit source]
Intermittent claudication (IC) is usually defined as pain in the legs when walking. [1][2] Intermittent claudication of vascular origin is often found in patients with peripheral artery disease, a condition involving the narrowing of blood vessels leading to restrictions in blood flow; in other cases, claudication is the result of compression of the spinal nerves caused by spinal stenosis (neurogenic claudication) or intermittent cauda equina compression syndrome. [3]
The diagnosis of IC is often established with the ankle-brachial index (ABI) obtained after a treadmill assessment. However, some patients can not go through treadmill testing due to (temporary) orthopedic or neurologic comorbidity or fear of falling. [1]
To help differentiate between these causes and provide some further insight into the underlying cause, a test called the Bicycle Test of Van Gelderen was developed.
Purpose[edit | edit source]
To determine whether the patient has intermittent claudication due to vascular or neurogenic insufficiency.[4]
Technique[edit | edit source]
The Bicycle Test of van Gelderen is a simple test that is combined with other clinical information from the routine neurological assessment. [4]
During this test, the patient is seated on a bicycle pedaling in an upright position first and then in a forward leaning position. If the patient reports symptoms of claudication in both positions then a vascular origin is suspected. If symptoms are reproduced while upright and relieved while leaning forward then spinal stenosis is the possible cause of claudication (i.e. the forward leaning position decompresses and reduces irritation of the spinal nerves).
Both submaximal and a maximal bicycle testing may be used for detecting intermittent claudication. [1]
Watch this video, [5] to get an idea of how the test is performed and used.
Evidence[edit | edit source]
Dyck et al. [4] suggest that the Bicycle Test of van Gelderen has concurrent validity to myelographic testing. It has been supported as an alternative noninvasive solution to treadmill testing for patients who are unable to perform the treadmill testing when aiming to detect intermittent claudication (98% sensitivity and 86% specificity for the submaximal testing protocol, 98% sensitivity and 43% specificity for the maximal testing protocol). [1]
Resources[edit | edit source]
Useful algorithm for differential diagnosis of neurogenic / vascular claudication
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Fokkenrood HJ, Houterman S, Schep G, Teijink JA, Scheltinga MR. Bicycle testing as an alternative diagnostic tool in patients suspected of intermittent claudication. Ann Vasc Surg. 2014 Apr;28(3):614-9.
- ↑ Cassar K. Peripheral arterial disease. BMJ Clin Evid. 2011;01:211.
- ↑ Huml E, Davies RA, Kearns GA, Petersen SM. Common iliac artery occlusion presenting with back and leg pain: case report and differential diagnosis considerations for neurogenic/vascular claudication. J Man Manip Ther. 2018; 26(5): 249-53.
- ↑ 4.0 4.1 4.2 Dyck P, Doyle JB Jr. "Bicycle test" of van Gelderen in diagnosis of intermittent cauda equina compression syndrome. Case report. J Neurosurg. 1977 May;46(5):667-70.
- ↑ Sleeper M. Bicycle Test for Spinal Stenosis. Available from: https://www.youtube.com/watch?v=bvRmPj7LRC0 [accessed 10/6/2024]
