The history and physical examination are an essential component in the assessment of patients with lumbar spinal stenosis. The differential diagnosis is broad, and many conditions may be ruled out with a thorough office evaluation. Peripheral neuropathy, arteriovascular disease, and hip arthrosis are common entities with similar symptoms. Imaging studies provide poor specificity. Clinical decision making should be based on a collection of data, including the history and physical findings, functional status, imaging and electrodiagnostic studies, and other adjunctive studies.