Lizbeth Alejandra Martinez Ochoa

Sciatica

Mexican University of the North

Cd. Juarez, Chihuahua, 2023
 Ciatalgia

Lizbeth Alejandra Martinez Ochoa

Ms. Paulina Piñón

UMN
INDEX
It is a pain along the course of the sciatic nerve. Generally, it is due to the
compression of the lumbar nerve roots in the lower part of the
back. The most common causes are an intervertebral disc herniation,
osteophytes and narrowing of the spinal canal (spinal stenosis). The
symptoms include pain that radiates from the buttocks down the leg. The
diagnosis may require magnetic resonance imaging or tomography
computerized. Electromyography and nerve conduction studies
allow identifying the affected level. The treatment includes measures of
support and, at times, surgery, particularly if there is neurological deficit.

Etiology of sciatica
Sciatica is caused by compression of the nerve root.
generally due to an intervertebral disc herniation, bone irregularities
(e.g., osteophytes from osteoarthritis, spondylolisthesis), spinal stenosis or,
less frequent, an intraspinal tumor or an intraspinal abscess. The
compression can occur within the spinal canal or the foramen
intervertebral. There may also be nerve compression outside of the
spine, in the pelvis or in the buttocks. Often, it affects the
L5-S1, L4-L5, and L3-L4 nerve roots (see table Motor effects and
reflexes of spinal dysfunction according to segmental level.

Signs and symptoms of sciatica

In patients with sciatica, the pain radiates along the
trajectory of the sciatic nerve (symptoms related to the roots)
nervous L4, L5, and S1), more frequently in the buttocks and face
back of the leg down to beneath the knee. It is a burning pain,
piercing or stabbing. It may or may not be accompanied by lower back pain. The
Valsalva maneuver or cough may worsen pain due to a
disc herniation. The patient may feel numbness and weakness in
the affected leg.
Thecompression of a nerve root it can cause a sensory deficit,
motor or in the reflexes, which is a more objective sign. The herniated disc
L5-S1 can affect the Achilles reflex; the L3-L4 hernia can affect
the patellar reflex.
The elevation of the extended leg can cause pain that radiates towards
the whole leg when raising it slowly above 60° or less. This
the sign is sensitive for sciatica; the pain that radiates towards the leg
affected when lifting the contralateral (crossed leg elevation)
extended) is a more specific sign of sciatica. The test of
elevation of the extended leg can be performed with the patient seated
with the hip flexed at 90°; the lower part of the leg is raised
slowly until fully extending the knee. In case of sciatica,
the pain in the spine (and often the radicular symptoms) appears when
extend the leg.
The depression test (slump test) can also be done in a way
similar to the straight leg raise test, but with the patient
sunk (with the thoracic and lumbar spines flexed) and the neck
flexed. The slump test is more sensitive but
less specific for disk herniation than the raise test of the
straight leg.

Diagnosis of sciatica
Clinical evaluation
Sometimes, MRI, electrodiagnostic studies, or both
Sciatica is suspected based on the characteristics of the pain. In that case,
the strength, reflexes, and sensitivity must be evaluated. If this deficit
neurological or if the symptoms persist for more than 6 weeks, they should
to undergo imaging studies and electrodiagnostics. The anomalies
structural factors that produce sciatica (including spinal stenosis) are
diagnosed by MRI or CT.
Electrodiagnostic studies allow for the confirmation of the presence and the
degree of compression of the nerve root and exclude conditions that may
simulate sciatica, like paralysis of the peroneal nerve,
amultiple mononeuropathyor onepolyneuropathyThese studies help
to determine whether the injury affects a single nerve level or multiple levels and if the
clinical signs correlate with abnormalities in MRI (especially
useful before surgery). However, it is possible that the anomalies may not be
evident in electrodiagnostic studies up to several weeks later
from the onset of symptoms.

Treatment of sciatica

Activity according to tolerance, analgesics, and sometimes medications that

they relieve neuropathic pain
Physical therapy
Sometimes, oral or epidural corticosteroids
Surgery in severe cases
Relief of acute pain secondary to sciatica after 24 to 48 hours of
bed rest in a reclining position with the head of the stretcher
elevated around 30° (semi-Fowler position). The measures for
treat lower back pain, including non-opioid analgesics (e.g., NSAIDs,
paracetamol), can be used for up to 6 weeks. The drugs that
they reduce neuropathic pain (seeAgents for pain
neuropathic), such as gabapentin or other anticonvulsants or
low-dose tricyclic antidepressants (there is none that is higher than the)
others), can relieve the symptoms. First, gabapentin is administered.
100 to 300 mg by mouth at bedtime; the dosage should be adjusted slowly
to avoid adverse effects that can impede recovery from
patient. As with all sedatives, caution should be exercised in
elderly, in patients at risk of falls, patients with arrhythmias, and in
those with chronic kidney disease.
Muscle spasms can be relieved with the application ofheatocold;
thephysical therapycan be useful. The use of corticosteroids for the treatment of
acute radicular pain is controversial. The epidural administration of
Corticosteroids can relieve pain, although they should not be used unless
whether it is intense or persistent. Some doctors try the
oral corticosteroids, but there is no strong evidence about their
effectiveness.
Surgery is indicated only in cases ofcauda equina syndromeo
for unconfirmed disc herniation accompanied by one of the following
síntomas:
Muscle weakness that worsens or does not resolve
Other progressive neurological deficits
Unbearable and intractable pain that interferes with work and
personal activities in an emotionally stable patient,
that has not decreased after 6 weeks of treatment
conservative
The chosen procedure is classic discectomy with laminectomy.
limited in intervertebral disc herniation. If the hernia is partial, it can
to undergo a microdiscectomy; in this case, the incision in the skin and the
laminotomy can be smaller. Chemonucleolysis, with
Intradiscal injection of chymopapain is no longer used.
The predictors of poor surgical outcomes include:
Important psychiatric factors
Persistence of symptoms for more than 6 months
Heavy manual labor
Predominance of back pain (non-radicular)
Secondary interests (i.e., litigation and compensations)

Key concepts
Sciatic pain is caused by the compression of the nerve root, by which
general due to an intervertebral disc herniation, osteophytes
osteoarthritis, spinal stenosis or spondylolisthesis.
The burning, stabbing, or piercing pain that radiates along the nerve.
sciatica is classic, most commonly going down through the buttocks and through the
back of the leg down to below the knee.
Loss of sensitivity, weakness, and deficit of reflexes may occur.
MRI and electrodiagnostic studies must be performed if there are deficits.
neurological or if the symptoms persist for more than 6 weeks.
Conservative treatment is usually sufficient, but it should be considered.
surgery for disc herniation if there is a progressive neurological deficit or a
intractable persistent pain.

Problem statement
How do patients learn to identify sciatica and differentiate it?
is it a false sciatica?
Theoretical Framework

Pain from irritation of the sciatic nerve occurs in the area of the spine
lumbar and radiates to one leg down to the foot, the pain is diffuse and
manifests as a cramp or tingling. It can be caused by
muscle contractures, distal hernia, spinal stenosis or
Spondylolisthesis. The pain is triggered by physical overexertion.
[Link]
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FisioClinics Palma
Pain can occur at any point along the sciatic nerve pathway.
with a tingling or pricking sensation, generally caused by
some compression (contracture of the pyramidal or piriformis) or others
factors; which we know as comociática, being one of the pains
most common issues addressed by our physiotherapy specialists
rehabilitation.
The pain of sciatica is characterized by being intense. It usually presents itself in
the lower lumbar area, possibly radiating to the buttocks, hip, the
legs and even up to the ankle. This pain tends to be addressed by the
physiotherapists and specialized osteopaths, who allow decompression of the
nerve and favor the analgesia of the symptoms.
The most common causes for presenting sciatica are the presence of
a disc herniation, spinal canal stenosis, or pyramidal syndrome.
The sciatic nerve can be divided into two types:

The first of type acute lasts up to six weeks.

2. The second typological: lasting more than six weeks.
[Link]
sciatica-treatment-at-fisioclinics-palma
Mayo Clinic. 01/27/23
Sciatica refers to the pain that travels along the path of the sciatic nerve.
the sciatic nerve extends from the lower back, going through the
hips and the glutes, down to each leg.

Sciatica usually occurs when a herniated disc or the

excessive growth of a bone exerts pressure on a part of the
nerve. This causes inflammation, pain, and often, some
numbness in the affected leg.

[Link]
causes/syc-20377435

Justification
Why is it relevant to know how to identify sciatic pain?
Most people fully recover from sciatica.
general, without receiving treatment. However, sciatica can damage the
nerves.

Loss of sensitivity in the affected leg

 Weakness in the affected leg
Loss of control of the bowels or bladder

It is important to identify the symptoms so that it can be addressed as soon as possible.

treaty, will reduce the pain in it, and find a treatment
opportune and efficient. To hope for a swift recovery.

Hypothesis

It is advisable to implement strategies to inform people.

from an early age to use preventive methods such as the following:
1. Take care of your posture.
If you have to stand, distribute your weight evenly and,
If possible, support one of your feet on a step or object.
elevated. When you sit, do it with a straight back and well
leaning back against the backrest and keep your feet on the ground, on a
footrest, if possible.
2. Also while you sleep.
Sleep on a hard mattress with a board underneath and do it on your side,
with a pillow between the legs to reduce pressure on the
back, or lying on your back, with a rolled towel under your neck and
pillows under the knees. When you get up, do it slowly,
sitting down first and then rising carefully.
Think about your back when you walk.
You stand with your back straight and your head held high, throwing back the
shoulders back. Remember, also, that you should avoid the
high-heeled shoes or too flat to avoid tension in
the back.
4. Carry out household chores with attention.
Also remember to maintain a proper posture while
you carry out daily activities. For example, kneel down
when you make the bed, distribute the weight between both arms when
returning from shopping or ironing, posing a foot on a box of
cardboard.
5. Bend your knees when lifting weights.
If you need to pick up a heavy object from the ground, do not bend your back.
Instead, bend your knees, keep your back straight and lift.
the object slowly, keeping it as close to the body as possible
and avoiding sudden movements.
6. At the wheel, don't forget your back.
Bring the seat closer so that your feet can reach the
pedals effortlessly and steering the wheel with both hands. If you
It's a long journey, take breaks every two hours to
do stretching exercises, especially if you work at the wheel.
7. Keep overweight in check.
The practice of daily exercise such as walking, stationary cycling or
Swimming helps to control weight and strengthen the lower back muscles.
We can also dedicate a few minutes in the morning to practice.
specific exercises to strengthen the abdomen, which sometimes
they can be part of the rehabilitation after the episode of
sciatica.
Heat and cold, good allies.
Thermal therapy can help us relieve pain in the area.
affected: apply ice or cold compresses for twenty minutes
every two hours for the first two days and, subsequently,
apply heat with an electric blanket, a hot water bottle or
a high temperature shower to improve circulation and the
healing process. Gentle massages or the application of
Ultrasounds are also recommended in some cases.
9. Learn to relax.
Relaxation techniques or exercising regularly
they can help you prevent stress and avoid it from accumulating
tension in the back muscles.
10. Consult your doctor or pharmacist.
Consult healthcare professionals about the use of analgesics and
anti-inflammatories to relieve pain and faithfully follow their
instructions. Never self-medicate.
Under a quantitative study design and a cross-sectional study type,
observational, analytical and retrospective included a universe of
workers entitled with a diagnosis of mechanical low back pain and
the sociodemographic characteristics of the patients of the medical unit
familiar No 48 in Ciudad Juárez, Chihuahua, Mexico and was carried out a
quantification of the cost of care at the primary care level (per
medium of the existing price tabulator in the Official Gazette of the
Federation) understood from March 1, 2019 to February 29 of
2020. Results. Data were obtained from 303 patients with the diagnosis
of mechanical low back pain during the study period. Of which 58.7%
They were female, 41.3% male, the average age
He was 24 years old, being overweight was the nutritional status with the highest report.
85% were operators in the maquiladora industry

Conclusion
Glossary
 References
Sciatica

ForPeter J. MoleyMD, Hospital for Special Surgery

Medically reviewed Oct. 2022

[Link]
ethical-and-connecting/neck-and-back-pain/sciatica
Mayo Clinic?

[Link]
20377435

[Link]

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