Difference between revisions of "Sciatica" - New World Encyclopedia

	Sciatica; Classification and external resources
	Left gluteal region, showing surface markings for arteries and sciatic nerve.
ICD-10	M54.3-M54.4
ICD-9	724.3
eMedicine	emerg/303
MeSH	D012585

Revision as of 00:41, 28 May 2007

SCIATICA

Sciatica is otherwise known as Sciatic nerve dysfunction or lumbar radiculopathy. This condition occurs when the sciatic nerve, which is the longest nerve in the body, becomes inflamed due to injury or compression.

The sciatic nerve is the primary nerve of the leg, orginating from the back of the pelvis and extending through the buttocks and down the back of the thighs. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot.

Sciatica involves pain, weakness, numbness in the lower back and legs. Some also experience a tingling sensation in the legs. It is a form of peripheral neuropathy.

A problem in a single nerve group, such as the sciatic nerve, is classified as a mononeuropathy. But when the nerve is partially damaged, the effects may seem similar to conditions such as tibial nerve dysfunction or common peroneal nerve dysfunction, which arise when certain branches of the Sciatic nerve are damaged. A ruptured lumbar disk in the spine may also cause symptoms that simulate the symptoms of sciatic nerve dysfunction.

Causes

Sciatica is usually caused by a prolapsed disk in the spine that presses on the sciatic nerve.

Discs are rings with tough exteriors and soft inside, which are located between the bones of the spine and function as shock absorbers. When a weak disc herniates (buges out), the bulge presses or even crushes the sciatic nerve, causing Sciatica.

Discs can become strained and weak because of a number of reasons:

Twisting and bending movements
Heavy lifting
Bad posture
Pregnancy
Obesity

Other medical conditions may also put pressure on the sciatic nerve:

Diabetes
Tumor
Abscess
Blood clot or bleeding in the pelvis
Nerve disorders

Causes also include direct trauma inflicted by an injection into the buttocks, fractures on the pelvis, gunshot wounds, prolonged external pressure on the nerve, pressure on the nerve from nearby body structures and nerve entrapment, which occurs when pressure is applied on the nerve when it passes through a narrow structure. The damage slows or prevents conduction of impulses through the nerve.

There are cases when the definite cause for Sciatica cannot be identified.

Risks

Sciatica may lead to complications such as:

Partial or complete loss of leg movement
Partial or complete loss of sensation in the leg
Recurrent or unnoticed injury to the leg
Side effects from medications such as painkillers

Signs & Symptoms

Dull, mild pain to sharp, extreme pain may occur anywhere along the entire length of the Sciatic nerve. The pain could lasts for weeks or occur only now and then, especially when sneezing or coughing. Physical activity may make the pain more intense.

Other symtoms include:

Numbness
Burning sensation
Tingling sensation (known as pins and needles)
Weakness in the affected area
Difficulty in walking
Inability to move the foot
Inability to bend the knee

Each individual may experience symptoms differently. For some, the symptoms are worse at night.

Diagnosis

Diagnostic procedures for Sciatica begin with analysis of the patient’s complete medical history and symptoms, and a physical examination. The patient may also be put through a number of flexibility and muscle-strength tests. This is followed by and a set of laboratory tests.

A neuromuscular examination of the legs could reveal:

Weakness of knee bending or foot movement
Difficulty bending the foot inward or down
Anormality in reflexes with weak or absent ankle-jerk reflex
Pain down the leg reproduced while lifting the leg straight up off the examining table

Clinical tests that reveal sciatic nerve dysfunction may include:

EMG (a recording of electrical activity in muscles)
Nerve conduction tests
Blood tests
X-rays
CT scans
MRI imaging

These test are also used to pinpoint the affected area of the spine and to rule out more severe spinal problems.

Treatment

Specific treatment for sciatica will be determined by factors such as:

Age
Overall health
Medical history
Extent of the disease
Expectations for the course of the disease
The patient’s tolerance / preference for specific medications, procedures or therapies

In some cases, no treatment is required and recovery is spontaneous. Where Sciatica heals on its own with rest and time.

But if the condition persists, treatment is required to relieve pain and maximize mobility:

Pain Relief

To keep the patient comfortable, nonsteroidal anti-inflammatory drugs or pain killers are prescribed. Depending on the severity of the condition, these may vary from a simple analgesic to phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline. Applying heat or cold to the affected area may also help.

When pain is so severe that the person is disabled, an epidural is administered. This is injected in the spine to bring quick relief. Though steroids may help with nerve inflammation, their use should be avoided or minimized to reduce the risk of medication side effects.

Physical Activity

Exercise goes a long way in helping reduce inflammation in the sciatic nerve. Walking, stretching and resuming normal work is sufficient for most. Though additional physical therapy exercises are recommended for some in order to maintain muscle strength.

The use of braces, splints, orthopedic shoes or other supportive devices may help compensate for lost or impaired function. Vocational counseling, occupational therapy, occupational changes, job retraining or similar interventions may also be recommended.

Surgery

This is recommended only if sciatica becomes overwhelming and lasts for a prolonged period. Surgery to repair the prolapsed disk will involve removing a part of the bulging disc, so that it is no longer pressing against the nerve.

Prevention

Prevention varies depending on the cause of the nerve damage. But, generally avoid prolonged sitting or lying with pressure on the buttocks.

Some form of regular exercises can also help prevent this condition.

References
ISBN links support NWE through referral fees

Retrieved from:

• “http://csmc.edu”

• “http://www.uchospitals.edu”

• “http://www.nlm.nih.gov”

Credits

New World Encyclopedia writers and editors rewrote and completed the Wikipedia article in accordance with New World Encyclopedia standards. This article abides by terms of the Creative Commons CC-by-sa 3.0 License (CC-by-sa), which may be used and disseminated with proper attribution. Credit is due under the terms of this license that can reference both the New World Encyclopedia contributors and the selfless volunteer contributors of the Wikimedia Foundation. To cite this article click here for a list of acceptable citing formats.The history of earlier contributions by wikipedians is accessible to researchers here:

Sciatica ^history

The history of this article since it was imported to New World Encyclopedia:

History of "Sciatica"

Note: Some restrictions may apply to use of individual images which are separately licensed.

@@ Line 13: / Line 13: @@
    MeshID        = D012585 |
 }}
-'''Sciatica''' is a sometimes severe [[Pain and nociception|pain]] caused by general compression and/or irritation of one of five nerve roots that are branches of the [[sciatic nerve]].  The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.
-Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term often is misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms often will be different, depending upon the underlying cause of the symptoms.
+==SCIATICA==
-The first cited use of the word "sciatica" was registered in 1450.<ref>Oxford English Dictionary, 2nd Ed. "a1450a Mankind (Brandl)."</ref>
+Sciatica is otherwise known as Sciatic nerve dysfunction or lumbar radiculopathy. This condition occurs when the sciatic nerve, which is the longest nerve in the body, becomes inflamed due to injury or compression.
-== Causes of sciatica ==
+The sciatic nerve is the primary nerve of the leg, orginating from the back of the pelvis and extending through the buttocks and down the back of the thighs. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot.
-Sciatica is generally caused by the compression of a lumbar spine nerve root L4 or L5 or [[Sacral nerves|sacral nerve roots]] S1, S2 or S3, or far less commonly, by compression of the [[sciatic nerve]] itself.  When sciatica is caused by compression of a lumbar <em>nerve root</em> it is considered a lumbar radiculopathy (or radiculitis when accompanied with an inflammatory response) from a [[spinal disc herniation]] (a herniated [[intervertebral disc]] in the [[spine (anatomy)|spine]]), or from roughening, enlarging, and/or misaligning of the [[vertebra]]e ([[spondylolisthesis]]), or [[degenerative disc disease|degenerated discs]].<ref>[http://www.spine-health.com/topics/cd/d_sciatica/sc02.html Spine Health.com]</ref>
+Sciatica involves pain, weakness, numbness in the lower back and legs. Some also experience a tingling sensation in the legs. It is a form of peripheral neuropathy.
-Sciatica may also be experienced in late [[pregnancy]], primarily resulting from the [[uterus]] pressing on the [[sciatic nerve]], and, secondarily, from the muscular tension and / or vertebral compression consequent to carrying the extra weight of the [[fetus]], and the postural changes inherent to pregnancy.
+A problem in a single nerve group, such as the sciatic nerve, is classified as a mononeuropathy.  But when the nerve is partially damaged, the effects may seem similar to conditions such as tibial nerve dysfunction or common peroneal nerve dysfunction, which arise when certain branches of the Sciatic nerve are damaged. A ruptured lumbar disk in the spine may also cause symptoms that simulate the symptoms of sciatic nerve dysfunction.
-"Pseudo-sciatica", which causes symptoms similar to spinal nerve root compression, is caused by the compression of peripheral sections of the nerve, usually from soft tissue tension in the [[piriformis]] or related [[muscle]]s. One possible cause of this is the [[piriformis syndrome]] (PMID 17030664). In this condition, the piriformis muscle, located beneath the gluteal muscles, contracts spasmodically and strangles the sciatic nerve beneath the muscle. Another cause of sciatic symptoms is [[sacroiliac joint]] dysfunction. Unhealthy postural habits, such as excessive time sitting in chairs, and sleeping in the fetal position, along with insufficient stretching and exercise of the relevant myofascial areas, can lead to both the vertebral and soft tissue problems associated with sciatica {{Fact|date=March 2007}}.
-Another source of sciatic symptoms is active [[trigger points]] of the lower back and the gluteus muscles. In this case, the referred pain is not consequent to compression of the sciatic nerve, though the pain distribution down the buttocks and leg is similar. Trigger points occur when muscles become ischemic (low blood flow) due to injury or chronic muscular contraction. The most commonly associated muscles with trigger points triggering sciatic symptoms are: the [[quadratus lumborum]], the [[gluteus medius]], the [[gluteus minimus]], and the deep hip rotators {{Fact|date=March 2007}}.
-One cause of sciatica is a [[spinal disc herniation]], pressing on one of the sciatic nerve roots. The spinal discs are composed of a spongiform cartilage with a liquid center. The discs separate the vertebrae, thereby allowing room for the nerve roots to properly exit through the spaces between the L4, L5, and sacral vertebrae. The discs cushion the spine from compressive forces, but are weak to pressure applied during rotational movements.  That is why a person who bends to one side, at a bad angle, to pick up a piece of paper may more likely herniate a spinal disc than a person falling from a ladder and landing on his or her back. Herniation of a disc occurs when the liquid center of the disc bulges outwards, tearing the external ring of fibers, and compresses a nerve root against the lamina or pedicle of a vertebra, thus causing sciatica.
+==Causes==
-Other compressive spinal causes include [[Spinal stenosis|Spinal Canal Stenosis]], a condition wherein the spinal canal (the spaces through which the spinal cord runs) narrows and compresses the spinal cord. This narrowing can be caused by bone spurs, vertebral dislocation, inflammation, or herniated disc which decreases available space for the spinal cord, thus pinching nerves in the spinal cord that travel to the sciatic nerve and irritating them with friction.
+Sciatica is usually caused by a prolapsed disk in the spine that presses on the sciatic nerve.
-The sciatic nerve runs through the piriformis muscle in the buttocks region. When the muscle shortens or spasms due to trauma, it can compress the sciatic nerve. This cause of sciatic symptoms is [[piriformis syndrome]], a major cause of sciatica. The approach to treating Sciatica is to reduce the compressive forces causing the pressure upon the sciatic nerve. This can be accomplished through traction and realignment therapeutic procedures in the case where the sciatica is spinal-related. Manual muscle stretching, massage, and mobilization techniques should be used when the sciatica is piriformis muscle-related. General therapeutic goals include helping the muscles loosen, thereby lessening pain, and to minimize inflammation.
+Discs are rings with tough exteriors and soft inside, which are located between the bones of the spine and function as shock absorbers. When a weak disc herniates (buges out), the bulge presses or even crushes the sciatic nerve, causing Sciatica.
-=== Self-infliction ===
+Discs can become strained and weak because of a number of reasons:
-The risk of self-inflicted sciatica has increased in recent years with the fashion trend of lower-hanging trousers as well as lower-positioning of the pockets. For instance, sitting on a wallet for prolonged hours every day can cause self-inflicted sciatica. Symptoms of numbness and/or pain behind the knee cap are associated with this form of sciatica.
+*Twisting and bending movements
+*Heavy lifting
+*Bad posture
+*Pregnancy
+*Obesity
-The corrective action of removing any objects from rear pockets and not sitting on uneven surfaces can reverse the symptoms of sciatica if the damage has not been too severe.
+Other medical conditions may also put pressure on the sciatic nerve:
-== Diagnosis and treatment ==
+*Diabetes
+*Tumor
+*Abscess
+*Blood clot or bleeding in the pelvis
+*Nerve disorders
-Because of the many conditions which can compress nerve roots and cause sciatica, treatment options often differ from patient to patient. Treatment of the underlying cause of the compression is often the most effective course. When the cause is due to a prolapsed or [[Spinal disc herniation|lumbar disc herniation]], research has shown that, with supportive treatment to help relieve pain, 90% of disc prolapse will recover with no specific intervention. Genetics appear to influence the risk of developing disc herniation.
+Causes also include direct trauma inflicted by an injection into the buttocks, fractures on the pelvis, gunshot wounds, prolonged external pressure on the nerve, pressure on the nerve from nearby body structures and nerve entrapment, which occurs when pressure is applied on the nerve when it passes through a narrow structure. The damage slows or prevents conduction of impulses through the nerve.
-Imaging methods such as MR neurography may help diagnosis and treatment of sciatica.  MR neurography has been shown to diagnose 95% of severe sciatica patients, while as few as 15% of sciatica sufferers in the general population are diagnosed with disc-related problems.<Ref>
+There are cases when the definite cause for Sciatica cannot be identified.
-{{cite web
-| url = http://www.thejns-net.org/spine/issues/v2n2/pdf/s0020099.pdf
-| title = Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.
-| author = ^
-| authorlink = http://www.neurography.com/aaronfiller.html Aaron G. Filler
-| coauthors = et al.
-| year = 2005
-| month = February
-| publisher = Journal of Neurosurgery: Spine
-| pages = p99-115
-}}</Ref> MR neurography is a modified MRI technique using MRI software to provide better pictures of the spinal nerves and the effect of compression on these nerves. MR neurography may help diagnose piriformis syndrome which is another cause of sciatica that does not involve disc herniation. MR neurography has limited geographic availability, but is covered by most insurance as a standard soft-tissue MRI.<ref>[http://www.neurography.com/gettingstarted-1.html MR neurography]</ref>
-Most cases of sciatica can be effectively treated by one or a combination of the following:
+==Risks==
-* [[Physical therapy]] and exercise, which generally is best done in a controlled, progressive manner and will include some combination of stretching, strengthening and cardio conditioning
-* [[Massage therapy]]
-* [[Chiropractic]] adjustments to restore proper joint mechanics and neurological signaling to the muscles. *
-* Appropriate changes in behaviour, ergonomics and environment (for example cushioning, chair and desk height, sleeping positions).
-* [[Anti-inflammatory medication]]s (i.e. [[NSAID]]s or oral [[steroid]]s),
-* [[Pain medication]]s (e.g. acetaminophen)
-* [[Osteopathic manipulation]]
-* [[Epidural#Epidural steroid injection|Epidural steroid injections]] to deliver local anti-inflammatory agents (and possibly a pain medication) directly to the affected area
-* [[Alternative medicine]] treatments such as [[acupuncture]]
-== See also ==
+Sciatica may lead to complications such as:
-* [[Back pain]]
-* [[Piriformis syndrome]]
+*Partial or complete loss of leg movement
-* [[Spinal disc herniation]]
+*Partial or complete loss of sensation in the leg
-* [[Laminectomy]]
+*Recurrent or unnoticed injury to the leg
-* [[Hemilaminectomy]]
+*Side effects from medications such as painkillers
+==Signs & Symptoms==
+Dull, mild pain to sharp, extreme pain may occur anywhere along the entire length of the Sciatic nerve. The pain could lasts for weeks or occur only now and then, especially when sneezing or coughing. Physical activity may make the pain more intense.
+Other symtoms include:
+*Numbness
+*Burning sensation
+*Tingling sensation (known as pins and needles)
+*Weakness in the affected area
+*Difficulty in walking
+*Inability to move the foot
+*Inability to bend the knee
+Each individual may experience symptoms differently. For some, the symptoms are worse at night.
+==Diagnosis==
+Diagnostic procedures for Sciatica begin with analysis of the patient’s complete medical history and symptoms, and a physical examination. The patient may also be put through a number of flexibility and muscle-strength tests. This is followed by and a set of laboratory tests.
+A neuromuscular examination of the legs could reveal:
+*Weakness of knee bending or foot movement
+*Difficulty bending the foot inward or down
+*Anormality in reflexes with weak or absent ankle-jerk reflex
+*Pain down the leg reproduced while lifting the leg straight up off the examining table
+Clinical tests that reveal sciatic nerve dysfunction may include:
+*EMG (a recording of electrical activity in muscles)
+*Nerve conduction tests
+*Blood tests
+*X-rays
+*CT scans
+*MRI imaging
+These test are also used to pinpoint the affected area of the spine and to rule out more severe spinal problems.
+==Treatment==
+Specific treatment for sciatica will be determined by factors such as:
+*Age
+*Overall health
+*Medical history
+*Extent of the disease
+*Expectations for the course of the disease
+*The patient’s tolerance / preference for specific medications, procedures or therapies
+In some cases, no treatment is required and recovery is spontaneous. Where Sciatica heals on its own with rest and time.
+But if the condition persists, treatment is required to relieve pain and maximize mobility:
+==Pain Relief==
+To keep the patient comfortable, nonsteroidal anti-inflammatory drugs or pain killers are prescribed. Depending on the severity of the condition, these may vary from a simple analgesic to phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline. Applying heat or cold to the affected area may also help.
+When pain is so severe that the person is disabled, an epidural is administered. This is injected in the spine to bring quick relief. Though steroids may help with nerve inflammation, their use should be avoided or minimized to reduce the risk of medication side effects.
+==Physical Activity==
+Exercise goes a long way in helping reduce inflammation in the sciatic nerve. Walking, stretching and resuming normal work is sufficient for most. Though additional physical therapy exercises are recommended for some in order to maintain muscle strength.
+The use of braces, splints, orthopedic shoes or other supportive devices may help compensate for lost or impaired function. Vocational counseling, occupational therapy, occupational changes, job retraining or similar interventions may also be recommended.
+==Surgery==
+This is recommended only if sciatica becomes overwhelming and lasts for a prolonged period. Surgery to repair the prolapsed disk will involve removing a part of the bulging disc, so that it is no longer pressing against the nerve.
+==Prevention==
+Prevention varies depending on the cause of the nerve damage. But, generally avoid prolonged sitting or lying with pressure on the buttocks.
+Some form of regular exercises can also help prevent this condition.
+==References==
+Retrieved from:
+• “http://csmc.edu”
+• “http://www.uchospitals.edu”
+• “http://www.nlm.nih.gov”
-== References ==
-<!-- ----------------------------------------------------------
-  See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a
-  discussion of different citation methods and how to generate
-  footnotes using the <ref>, </ref> and  <reference /> tags
------------------------------------------------------------ —>
-<div class="references-small"><references /></div>
-== External links ==
-* [http://www.spine-health.com/sciatica/ Sciatica Health Hub]
-* [http://hubpages.com/hub/get-relief-from-sciatica/ Pilates can help]
-* [http://www.back-pain.co.uk/conditions.html#SCIATICA Specific treatment instructions for sciatica]
-* [http://www.spine-health.com/topics/cd/d_sciatica/sc01.html What you need to know about sciatica]
-* [http://www.nytimes.com/2006/11/22/health/22spine.html NYT: Study Questions Need to Operate on Disk Injuries (register to view)]
-* [http://www.spineuniverse.com/displayarticle.php/article4122.html  Causes of Sciatica]
-* [http://www.back-pain-advisor.com/sciatica.html A Lay Persons guide to Sciatica, it causes and treatment]
-* [http://health-net.blogspot.com/2007/05/demystifying-sciatica.html Demystifying Sciatica]
 [[Category:Life sciences]]
 {{credit|132832605}}


Sciatica Classification and external resources
Left gluteal region, showing surface markings for arteries and sciatic nerve.
ICD-10	M54.3-M54.4
ICD-9	724.3
eMedicine	emerg/303
MeSH	D012585