sciatica
Introduction
Introduction to sciatica Sciatica refers to the area along the sciatic nerve, with radioactive pain mainly on the arm, the back of the thigh, the posterior aspect of the calf, and the lateral aspect of the foot. It is a symptom caused by various diseases and is divided into root and dry sciatica. According to the lesion, it is divided into two categories: root and dry. It occurs mostly on one side and is more common in young men and young adults. basic knowledge The proportion of sickness: 0.01% Susceptible people: more common in young adults Mode of infection: non-infectious Complications: lumbar disc herniation
Cause
Cause of sciatica
Cause:
The cause of primary sciatica (sciatic neuritis) is unknown and clinically rare.
Secondary sciatica is caused by compression or stimulation of adjacent lesions, and is divided into root and dry sciatica, which refers to whether the compression site is in the nerve root or in the nerve trunk.
Root sciatica (40%):
The most common lumbar disc herniation, often caused by acute, subacute onset, such as exertion, bending or strenuous activity. A few are chronic onsets. Pain often radiates from the waist to one side of the buttocks, behind the thighs, from the armpits, outside the calves, and to the feet. It is a burning or knife-like pain. The pain can be aggravated by coughing and exertion, and even worse at night.
Dry sciatica (25%):
The onset of illness also varies with the cause. If the cold or trauma induced more acute onset. Pain often radiates from the buttocks to the back of the thigh, the posterior aspect of the calf, and the outside of the foot. Pain worsens when walking, moving, and pulling the sciatic nerve. The tenderness point is below the hip point, the Lasegue sign is positive and the Kernig sign is more negative, and the scoliosis is more bent to the affected side to reduce the pulling of the sciatic nerve trunk.
Prevention
Sciatica prevention
Precautions
1, the hard bed rest, you can insist on doing gymnastics on the bed.
2, to work and rest, regular life, appropriate participation in various sports activities.
3, after exercise, pay attention to protect the waist and affected limbs, underwear should be changed in time after sweating, to prevent wet clothes from being dried on the body, not to take a shower immediately after sweating, to wash after sweating, to prevent cold, subject to wind.
Prevention common sense
1, pay attention to keep warm: prevent sciatica, first of all, we should pay attention to avoid the invasion of the cold, especially in winter, should pay attention to do the necessary warmth.
2, correct bad posture and posture: usually some people may have some bad sitting posture, the old saying goes, standing there is standing, sitting and sitting, so the usual posture must pay attention to keep correct, must pay attention to the bad posture Correct it in time.
3, work and rest: work and rest is also a key measure to prevent sciatica, we should pay attention not to excessive fatigue so as not to increase the pressure on the waist, accidents.
4, moderate exercise: For those who have been working in the office for a long time, prevention of sciatica must pay attention to the proper time to get up and exercise, and should do some appropriate exercise when rest, relieve local pain.
Complication
Sciatica complications Complications lumbar disc herniation
1. Usually appear as a complication of other diseases, such as lumbar disc herniation.
2. If it is the primary disease, it can be crippled.
Symptom
Symptoms of sciatica Common symptoms Back pain, tail pain, refusal to sit, skin pain, severe pain, persistent pain, buttocks, lightning pain, thighs or knees... Spine lateral lumbar stiffness, right leg numbness
History and symptoms
Sciatic neuropathy is more common in middle-aged and older men. It has more unilateral and rapid onset. First, it feels soreness in the lower back and waist stiffness. Or a few weeks before the onset, there are short-term pain in the lower limbs during walking and exercise. It develops into severe pain. The pain starts from the waist, hips or hips, down the back of the thigh, the axilla, the outside of the calf and the back of the foot. On the basis of persistent pain, there is a burst of burning or acupuncture. Painful, more serious at night.
First, root sciatica
Onset varies with the cause, the most common lumbar disc herniation, often under the inducement of exertion, bending or strenuous activity, acute or subacute onset, a small number of chronic onset, pain often from the waist to one side of the hip, After the thigh, the armpit, the lateral side of the calf and the foot are radiated, which is a burning or knife-like pain. The pain can be aggravated when coughing and exerting force. Even more so at night, the patient often takes special pain relief to avoid nerve pulling and compression. Posture, such as lying to the healthy side when sleeping, hips, knees flexing, standing on the healthy side when standing, causing scoliosis for a long time, bending to the healthy side, sitting into the buttocks to the healthy side to reduce the nerve roots Pressing and pulling the sciatic nerve can induce pain, or the pain is aggravated. For example, the Kernig sign is positive (the patient is supine, the hip and knee are at right angles, and then the lower leg is lifted. Because of the flexor tendon, the knee extension is limited and less than 130 degrees. There is pain and resistance); the straight leg raising test (Lasegue sign) is positive (the patient is lying on his back, the lower extremity is extended, the affected limb is lifted less than 70 degrees and causing leg pain), and the sciatic nerve pathway may have tenderness, such as the waist point. , hip point, country point, point and point, etc. The outside of the calf and the back of the affected limb often have numbness and sensation, the gluteal muscles are loose, the thumb and flexor muscles are weakened, and the Achilles tendon reflexes are weakened or disappeared.
Second, dry sciatica
The onset of illness also varies with the cause, such as cold or trauma induced by more acute onset, pain often from the buttocks to the back of the thigh, the lower back of the calf and the lateral side of the foot radiation, walking, activity and traction of the sciatic nerve when the pain is aggravated, tender points Below the hip point, the Lasegue sign is positive and the Kernig sign is more negative, and the scoliosis is more bent to the affected side to reduce the pulling of the sciatic nerve trunk.
Examine
Sciatica check
ESR can be increased, anti-"O", rheumatoid factor can be abnormal, spinal X-ray film, if necessary, in addition to lumbosacral X-ray film, but also ankle X-ray, lumbar CT, MRI There may be corresponding changes, such as intraspinal space-occupying lesions, lumbar puncture CSF examination protein increased, if necessary, spinal angiography to confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of sciatica
According to the location of the pain and the direction of the radiation, the factors that aggravate the pain, the pain relief posture, the traction pain and the tenderness point are not difficult to diagnose, but it is important to determine the cause.
First, lumbar disc herniation: patients often have a long history of repeated low back pain, or heavy physical labor history, often in an acute injury after a lumbar injury or bending work, in addition to the symptoms and signs of typical root sciatica, and waist Tendons, limited lumbar motion and loss of anterior lumbar flexion, intervertebral disc herniation can have obvious tenderness and radiation pain. X-ray films may have narrowed intervertebral space, and CT examination can confirm the diagnosis.
Second, the horsetail tumor: the onset is slow, gradually worsening, the disease is often unilateral root sciatica, gradually developed into bilateral, nocturnal pain is significantly increased, the course of disease is progressively aggravated, and sphincter dysfunction and saddle area sensation, lumbar vertebrae Puncture has subarachnoid obstruction and cerebrospinal fluid protein quantitation is significantly increased, and even Froin sign (cerebrospinal fluid yellow, self-coagulation after placement), spinal iodine angiography or MRI can be diagnosed.
Third, lumbar spinal stenosis: more common in middle-aged men, often in the early "intermittent claudication", lower limb pain after walking, but the symptoms are reduced or disappeared after walking or resting, when the nerve root or pony tail is severely stressed, Symptoms and signs of sciatica on one or both sides may also occur. The course of the disease is progressively aggravated. The treatment of bed rest or traction is ineffective. The lumbosacral X-ray or CT can confirm the diagnosis.
Fourth, lumbosacral radiculitis: due to infection, poisoning, nutritional metabolism or strain, cold and other factors, generally onset more acute, and the damage often exceeds the sciatic innervation area, showing the entire lower limb weakness, pain, light Muscle atrophy, in addition to Achilles tendon reflexes, knee tendon reflexes often weaken or disappear.
In addition, it is also necessary to consider lumbar tuberculosis, vertebral metastases, etc. When dry sciatica, attention should be paid to the history of cold or infection, as well as the ankle, hip, pelvic and hip lesions, except when necessary. X-ray radiographs can also be performed on the ankle joint X-ray, anal finger, gynecological examination and pelvic organ B-ultrasound to determine the cause.
