What is Sciatica?
Sciatica is defined as pain in the distribution of the sciatic nerve or its component nerve roots.
The syndrome is now accepted as being caused by lumbar disc prolapse. However, sciatic nerve lesions can occur due to pressure in the buttock or upper part of thigh.
Causes of Sciatica
True sciatic neuritis
In leprosy, polyarterities nodosa, nerve injury due to injections or trauma, post herpetic neuralgia.
- Mechanical pressure on nerves or roots or referred pain
- In spinal cord tumors of cauda equine, hemorrhage or infection irritating meninges of cord.
- In cord space protruded intervertebral disc, extramedullary tumors.
- In vertebral column arthritis, tuberculosis, ankylosing spondylitis, primary bone tumors, secondary carcinoma.
- In thigh and buttocks fibrositis, sacrosciatic band, misplaced injection.
- In pelvis sacroiliac arthritis, hip disease, sacroiliac strain.
Sciatica Clinical features
- Usually there is a history of previous attacks and history of trauma and exposure to damp and cold.
- Patient complains of pain down the leg on coughing in root lesions.
- On examination
- SLR test (straight leg raising test) restriction of SLR is much marked in lesions of nerve roots than purely skeletal affection. SLR test is a useful indication of the severity of sciatica.
- Popliteal compression test radiating pain is often aggravated by pressure over the course of tibial nerve through popliteal fossa.It is an additional finding in favor of root compression.
- Knee and ankle jerks when L4 is involved knee jerk is depressed and there is likely weakness of tibialis anterior muscle. S1 root ankle jerk lost and weakness when present involves the calf muscle.
- Tone and size of gluteal muscle is judged by asking patient to contract both buttocks; in upper sacral root lesions marked wasting of muscle may be clearly seen.
Investigation of Sciatica
- Xray spine is done for detecting disc narrowing in lumbar spine or lesion of hip joint.
- MRI best mean for assessment of root lesion.
- Cerebrospinal fluid may show increased protein with normal cell count in large protruded disc.
- EMG may be useful to confirm presence of degeneration of affected muscles.
- Procaine injection test for diagnosis of fibrositic pain.
How to Manage and get relief from Sciatica
- Acute stage
- Bed rest with boards under mattress of support the back.
- Analgesics as required.
- Heat fomentation.
- 2% procaine or lignocaine injection into sciatic nerve or epidural space or tender spots in the sacroiliac region may give dramatic relief.
- Chronic stage
- Management of cause.
- Injection of tender spots with 5% procaine.
- Counter irritation, heat and massage.
- Epidural injection with Novocain once a week.
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