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Answer 3
  1. Spinal stenosis. The distribution of joint abnormalities in this patient suggests the diagnosis of primary osteoarthritis, which is a generalized process that involves the spine in a diffuse manner. Spinal stenosis most commonly results from degenerative changes of the facet joints and the vertebral discs, although a congenitally narrow spinal canal can be a factor as well. The classic history of spinal stenosis is exacerbation with back extension, such as occurs with walking, and relief on flexion (hence the improved walking tolerance when leaning on a grocery cart). Pain is eased with sitting, as in vascular claudication, but the palpable pulses make the diagnosis of vascular claudication less likely.

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