SCIATICA

NAME : MUZDALFA QURESHI

SUBJECT: SUPERVISED CLINICAL PRACTICE
ROLLNUMBER:18221
SUBMITTED TO : DR ABDUL RASHAD
CONTENT 1
• S C I AT IC A

• E T I O LO G Y

• ONSET

• TO P O G R A P H Y

• Clinical pictures

• C L I N IC A L E X A M I N AT I O N

• C L I N IC A L F O R M S O F S C I AT I C A

• DI F F E R E N T I A L DI A G N O S I S

• IMAGING

• T R E AT M E N T

• C L I N IC A L C A S E ST U DY F O R S C I AT I C A
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SCIATICA
• Sciatica is pain in the lower extremity resulti ng
from irritati on of the sciati c nerve. The pain of
sciatica is typically felt from the low back (lumbar
area) to behind the thigh and radiati ng down
below the knee & may reach the foot .

• Most frequent radicul ar pain syndrome of spi nal

origin.

• Occurs due to irritation of a spinal ner ve root

associated with disc herni ation at L4-L5 OR L5-S1.

• Pain usually begins in the lower back radiating to

the sacroil iac regions, buttocks ,thighs ,cal f &
foot.

• Sciatica is a symptom , NOT A DIAGNOSIS.

Etiology
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• Disc herniation

• Spinal stenosis

• PIRIFORMIS SYNDROME:

• Spondylolisthesis :

• other causes :
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Disc herniation :

may occur in diff erent levels

of lumbosacral vertebrae ,
but the most common are
L5 or S1 .
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• Spinal stenosis: i s a n a r r o w i n g w i t h i n t h e v e r t e b ra e o f
the spinal column that results in too much pressure on the
spinal cord . The most common causes of spinal stenosis
are related to the aging process in the spine

• PIRIFORMIS SYNDROME: Neuromuscular syndrome that

occurs when the sciatic nerve is compressed /irritated by
the piriformis muscle causing pain, tingling & numbness in
t h e b u t t o c k s & a l o n g t h e p a t h o f s c i a t i c n e r v e . Wa l l e t
s c i a t i c a / f a t w a l l e t s y n d r o m e . C a u s e d / a g g ra va t e d b y s i t t i n g
w i t h a l a r g e w a l l e t i n t h e a ff e c t e d s i d e ’s r e a r p o c k e t .
Acupuncture to relieve pain

• S p on dy lo list he sis : d e g e n e ra t i v e c a u s e o f s p i n a l s t e n o s i s
w h i c h i s a n t e r i o r o r p o s t e r i o r d i s p l a c e m e n t o f v e r t e b ra .

• other causes : include irritation of the nerve from

adjacent bone, tumors, muscle, internal bleeding,
i n f e c t i o n s , i n j u r y, a n d o t h e r c a u s e s . S o m e t i m e s s c i a t i c a c a n
occur because of irritation of the sciatic nerve during
p r e g n a n c y.
ONSET 6

• Onset is often traumatic.

• Exertion or a forced movement results in acute

low back pain, followed by referral to the leg.

• Exacerbated by standing, sitting, exertion,

coughing and sneezing.

• Relieved by lying down.

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TOPOGRAPHY
• It ’s referral p attern follows that of
L5 or S1 territor y:

• L5:but tock , an terior aspec t of

th igh , lateral malleolus, dors um of
foot, g reat toe or the med ial 3
toes.

• S1:buttock ,p osterior aspect of

th igh , k nee, leg & heel, to the sole
or lateral s id e of the foot unto the
fi f th toe.

• In the distal limb, p ain may be

re placed by tin gling or numbnes s .
 Clinical pictures 8

• PAIN: T he mo st c om m on s ym pt o m f r om s c ia t i ca .
Mo st pe op le d e sc r ib e a d e ep, se ve re p a i n t hat
s ta r t s l ow on o ne si d e of t he b a ck a nd t hen s hoot s
do wn the b ut toc k a nd t he le g wi t h c er t a i n
movem ent s . In m os t pe op l e, t he pa i n i s m a de
wor s e b y sne e z i ng , c oug hing , l a ug hi ng, or a ha r d
bo we l move m ent . Be ndi ng b a ck wa r d ca n a ls o ma ke
the p a i n w ors e . You may a ls o n oti c e a w ea kne s s of
the l e g or foot , a lo ng wi th the p a i n. The w ea k nes s
may be c om e so b ad pa t ie nt c an' t m ove his foot

• Numbness.

• Walking diffi culty

 CLINICAL EXAMINATION 9
• The phys ical examination of s ciatic patients s hould
includ e : ob se r vatio n, palpatio n, de termination of
the rang e of motion of the s pine , a root te nsion
te st and evaluation of the ne urolo gical s tatus of
the lowe r limb s

• straight leg raising test “Lasègue sign“

• Patient in supine position

• Examiner lif ts the leg gradually with the knee

kept straight.

• Between 30 and 70 degree nerve comes into

contact with the prolapsed disc & the patient
complaints of pain.
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LASEGUE’S SIGN:
• M O DI F I C AT IO N O F S L RT.

• H I P I S F L E X E D & T H E K N E E I S A L S O F L E X E D AT 9 0 D E G R E E S

• T H E K N E E I S T H E N G R A D U A L LY E X T E N D E D B Y T H E E X A M I N E R .

• I F N E R V E ST R E TC T H I S P R E S E N T: PAT I E N T W I L L E X P E R I E N C E
PA I N I N T H E B A C K O F T H I G H O R L E G .

Slump test. This test includes the patient

seated upright with hands behind the back. The
patient bends (slumps) forward at the hip. The
neck is bent down with the chin touching the chest
and one knee is extended to a degree possible. If
pain occurs in this position, sciatica may be
present.
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SIGNS IN LUMBAR ROOT COMPRESSION
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CLINICAL FORMS OF SCIATICA

HYPERALGIC SCIATICA
• C h a ra c t e r i z e d b y s e v e r e p a i n

• P a t i e n t p r e f e r s t o r e m a i n i n b e d & i s h e s i t a n t e v e n t o m o v e s l i g h t l y.

• S p e c i fi c f o r m : m ya l g i c s c i a t i c a

Myal gic sciatica

• S e e n m o s t c o m m o n l y i n d i s c h e e r n i a t i o n s a ff e c t i n g S 1 n e r v e r o o t .

• Neuralgic pain is associated with intense & often continous muscular

p a i n s a n d c ra m p s a ff e c t i n g t h e b i c e p s f e m o r i s , t r i c e p s s u ra e &
ocasionally the gluteal muscles.

• M i l d m o t o r d e fi c i t .

• Fa s c i c u l a t i o n ' s
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PARALYTIC SCIATICA
• Sli g ht m oto r de fi c i t ca n be
de te cte d .

• Mor e fr e q uent i n L 5 s ci a ti c a

• Mos t of te n pa ra l yt ic L5 s ci a ti ca
le a ds to fo ot dr op, whi ch fo rc e s
the p a ti en t to mo di fy t he g ai t
pa t te r n.
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DIFFERENTIAL DIAGNOSIS
• S P O N DY LOA RT H R O PAT H Y

• Usually seen in the young.

• Pa i n d o e s n o t r e fe r d i s t a l t o t h e k n e e .

• B i l a t e ra l o r a l te rn a t i n g o c c u r i n g e p i s o d i c a l l y.

• N o t m od i fi e d b y a c ti v i ty.

• Nocturnal pain is common.

• D i a g n o s i s : PA V i e w s o f p e l v i s o r s p e c i a l i z e d h i b b s v i e w o f t h e s a c r o i l l i a c j o i n t s .

• E S R i s e l e va t e d .

• Ra p i d r e s p o n e t o m e d i c a t i o n .

• I N T R A M E D U L L A RY T U M O U R S ( G L IO MA S )
• Noct urna l p a in is co mm on 15

• Pa t i ent w il l s ta nd o r wa lk t o b ri ng r el i ef.

• Phys i ca l a c ti vi ty ha s no infl uenc e on t he pa i n.

• Spi ne i s s om et i me s ver y s t iff .

• Rad io g ra hic s t udi e s a r e nor ma l

• D ia g nos is : c t / myel og ra phy

• Sur ge r y r e l ie ves the p a ti e nt

• Me t as t a t ic l ei s ons o r a m ult ip l e mye l om a ca n re s ult in int ens e r e f ra ct or y s ci a t ic

pa i n.

• Infe ct i ous d is c it i s

• Infe ct i ous s a cr o il l it is
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IMAGING
• R A DIOGR AP H Y Mos t oc ca s io ns ra d i ogra phs is no rm a l Los s of lum b ar lor d io s is
Sco li os is Re duc ed i nt er ver t eb ra l d i sc s p s ce .

• C T Mo rp hol og ic a b nor ma l i ti es in re l a ti on t o a he r ni a t ed d i sc . Re l at i ve im pa c t on

a dj ace nt s of t t i ss ue s Any neur ofora m i nal o r e xt ra fora mi na l e ncr oa c hme nt .

• MY E LOG R AP H Y  Exce l le nt for a s s es i ng the e nt ir e s ub a ra c hnoi d s pa c e.  A s s es m ent

of s p ina l s t eno si s  D i s ad va nta g e s: hea d ac he ’s , na us ea

• DI SCOG RA P H Y  Of t en ne g le c te d mo d al i ty  Exc el le nt m ea ns of a s se s i ng di s c
pa t hol og y

• Ma g ne ti c r es ona nc e i ma g ing  ST UDY OF CH OICE for r ec ur r enc e fo ll ow ing

di s e ct omy, t o d i ff e re nt ia t e re c ur r ent he r nia t io n f r om p er i ne ura l fi b r os i s.  D et e ct
ot her le i so ns.
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TREATMENT

• CONSERVATIVE MANAGEMENT

 Int er m it te nt b ed r e s t wi t h m ovem e nt for s ho r t pe r iod s in b e tw ee n.

 Pa ti e nt sh oul d li e on a fi r m m at t r es s , in t he pos i t ion tha t fee l s m os t co mfo r ta b le .

 R i gi d l umb a r or t hos i s c an s hor te n the d ura t io n or o b via t e the ne e d for be d r es t .

 H ea t /co ld a p pl i ca t io n

• ANALGESICS & ANTI INFLAMMATORY DRUGS

 In hyp era lg ic for ms , i nt ra the c a l inj ec ti on of s t e roi d s b y LUC H ER I NI ’S t e c hni q ue ca n

pr o duc e a r e ma r k ab le re d uct i on i n p a in

 Ep id ural ana l ge s ia in s eve r e ca s e s.

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TREATMENT

• SURGERY

 Whe n ne ur ol ogi c al de fi c it is p r e se nt

 Fa i l ure of c ons er va t ive m a na ge me nt

 Che mo nucl eo loy s is

 Pe r c uta ne ous d i se c tomy

• REHABILITATION

 T HE RA P E UT IC E XER CI SES
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CLINICAL CASE STUDY FOR SCIATICA
• NAME:ABC..

• M a l e R . C ., A G E : 4 0 y e a r o l d – S c i a t i c a

• A patient was presented with the exacerbated chronic lower back pain in the Sacral region with irradiation
t o t h e b a c k o f t h e l e f t l e g , p r o d u c i n g a s t r o n g p a i n t h r o b b i n g a n d b u r n i n g b e h i n d t h e k n e e . Pa i n w a s
aggravated when bending forward or in reaching out position.

• In his history he had a back condition from birth and later had an accident that resulted in fracture of the
l u m b a r v e r t e b r a e . F r o m t i m e t o t i m e h e s u ff e r e d w i t h t y p i c a l s c i a t i c a p a i n . T h i s t i m e h e h a s b e e n s u ff e r i n g
for about two weeks.

• His MRI two months prior to this aggravation showed degeneration of L1, disc degeneration, and protrusion
of the disc at the S1 level.

• H e w a s p r e s c r i b e d s t r o n g n o n - s t e r o i d p a i n m e d i c a t i o n t h a t m a d e h i m f e e l d r o w s y, b u t d i d n o t p r o v i d e a f u l l
p a i n r e l i e f. S e e k i n g r e s o l u t i o n f o r h i s p a i n h e d e c i d e d t o t r y I n t e r X t h e r a p y.

• T h e fi r s t t r e a t m e n t h e f e l t t h e p a i n s u b s i d e , b u t p a i n r e l i e f d i d n ’ t l a s t a n d t h e p a i n r e o c c u r r e d a f t e r a f e w
hours.
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CLINICAL CASE STUDY FOR SCIATICA
• T h e se c o n d t re a tm e n t alt ho u gh p ain te mp or a r ily re du c e d , la te r h e fe lt w or s e . F ro m th a t p oin t a n d
on w a r ds h e us e d th e P er s o na l In te r X de vic e to s us ta in pa in re lie f. He h ad to g o a b ro ad a nd t oo k his
p e r so n a l I nt e r X d e v i c e w it h th e d u al fle x ar r a y fo r e ve r y d ay tre atm e n t p roto c ol th a t I s up p lie d h im
w ith .

• Tre a tm e nt w a s a i me d a t L 1, S 1 /S2 , S c a n th e w h ole L u mb a r – S ac r al z on e , de r mat om e s L 1 / L 2 a nd

L 4 , L 5 , S 1 – S 3 , Tr i g e m in al p oin ts , F le x ib le ar r ay to L u mb ar, le ft b u tto c k , r igh t b u tt oc k , le ft b ac k o f
th e k n e e .

• A fte r tw o a n d a h a l f w e e k s u s e , h e re p or t e d no p ain , n o d isc om fo r t, h e sto p p e d tak in g p ain

m e dic a ti o n a nd s ta r te d w ith t he c ore e xe rc ise prog r am t o s tab ilise the lum b ar s p in e .

• A d vic e t o l i m it dr i v i n g, p rolon g s itt ing , re st , g oo d nu tr itio n , a nd g e n tle st re t c h in g e xe rc ise s .

• S ix m o n th s fo l l o w u p c on fir m e d th at th e p atie n t st ill d id n ot h ave sc iat ic a p ain , a c tive ly w or k in g a n d

tr a ve l l i ng .
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ARTICLE

• Four clinical assessment items were common in

both reference standard defi nitions of sciatica. A
simple scoring tool for identifying sciatica was
developed. These criteria could be used clinically
and in research to improve accuracy of
identifi cation of this subgroup of back pain
patients.
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REFERENCE
• ht tp s: //www.s pi ne- h ea lt h. com /

• ht tp s: //in te r xc li nic . com /c as e- st ud y- 1 0- s ci a tic a /

THANK YOU

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