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Sciatica

Symptoms of a sciatica may often be difficult to distinguish from those of other spinal disorders or simple back strain

Clinical evaluation

The most common levels for a sciatica are L4-5 and L5-S1. The onset of symptoms is characterized by a sharp, burning, stabbing pain radiating down the posterior or lateral aspect of the leg, to below the knee. Pain is generally superficial and localized, and is often associated with numbness or tingling. In more advanced cases, motor deficit, diminished reflexes or weakness may occur herniated disc, disk, hernia, herneated, herniated disc, disk, hernia, herneated, sciatica, siatica

If a sciatica is responsible for the back pain, the patient can usually recall the time of onset and contributing factors, whereas if the pain is of a gradual onset, other degenerative diseases are more probable than disc herniation.

Rheumatoid arthritis often begins in the appendicular skeleton before progressing to the spine. Inflammatory arthritides, such as ankylosing spondylitis, cause generalized pain and stiffness that are worse in the morning and relieved somewhat throughout the day.

Cauda equina syndrome. Only the relatively uncommon central disc herniation provokes low back pain and saddle pain in the S1 and S2 distributions. A central herniated disc may also compress nerve roots of the cauda equina, resulting in

Low back strain should be differentiated from central herniated disc. Pain caused by low back strain is exacerbated during standing and twisting motions, whereas pain caused by central disc herniation is

Physical and neurologic examination of the lumbar spine

External manifestations of pain, including an abnormal stance, should be noted. The patient's posture and gait should be examined for sciatic list, which is indicative of disc herniation. The

Range of motion should be evaluated. Pain during lumbar flexion suggests

Motor, sensory and reflex function should be assessed to determine the

Specific movements and positions that reproduce the symptoms should be documented. The upper lumbar region (L1, L2 and L3) controls the iliopsoas muscles, which can be evaluated by testing resistance to hip flexion. While seated, the patient should attempt to raise each thigh while the physician's hands are placed on the leg to create resistance. Pain and weakness are indicative of upper lumbar nerve root involvement. The L2, L3 and L4 nerve roots control the quadriceps muscle, which can be evaluated by manually trying to flex the actively extended knee. The L4 nerve root also controls the tibialis anterior muscle, which can be tested by heel walking.

The L5 nerve root controls the extensor hallucis longus, which can be tested with the patient seated and moving both great toes in a dorsiflexed position against resistance. The L5 nerve root also innervates the hip abductors, which are evaluated by the Trendelenburg test. This test requires the

Cauda equina syndrome can be identified by unexpected laxity of the anal sphincter, perianal or

Nerve root tension signs are evaluated with the straight-leg raising test in the supine position. The physician raises the patient's legs to 90 degrees. Normally, this position results in

The most common sites for a herniated lumbar disc are L4-5 and L5-S1, resulting in back pain and pain radiating down the posterior and lateral leg, to below the knee.

A crossed straight-leg raising test may suggest nerve root compression. In this test, straight-leg raising of the contralateral limb reproduces more specific but less intense pain on the affected side. In

Nonorganic physical signs ( Waddell signs) may identify patients with pain of a psychologic or socioeconomic basis. These signs include superficial tenderness, positive results on simulation tests (ie, maneuvers that appear to the patient to be a test but actually are not), distraction tests that

Imaging of the herniated disc

The major finding on plain radiographs of patients with a herniated disc is decreased disc height. Radiographs have limited diagnostic value for herniated disc because degenerative changes are

The gold standard for herniated disc is magnetic resonance imaging (MRI). MRI has the ability to demonstrate disc damage, including anular tears and edema. MRI can reveal bulging and

Treatment of herniated disc

The majority of patients experience resolution of their symptoms regardless of the treatment method. About 70 percent of patients have a marked reduction in leg pain within four weeks of the onset of

Bed rest in excess of two days is not associated with a better outcome and continuing to perform

Analgesics

Naproxen ( Naprosyn) 500 mg followed by 250 mg PO tid-qid prn [250, 375,500 mg].

Naproxen sodium ( Aleve) 200 mg PO tid prn.

Napro xen sodium (Ana prox) 550 mg, followed by 275 mg PO tid-qid prn.

Trigger point injections can provide extended relief for localized pain sources. An injection of 1 to 2 mL of 1 percent lidocaine (Xylocaine) without epinephrine is

Indications for herniated disc surgery. While most patients with a herniated disc may be