sciatica
Introduction
Introduction Sciatica refers to sciatic neuropathy, a group of painful symptoms that occur along the sciatic nerve pathways, namely the lower back, buttocks, back of the thigh, posterior aspect of the lower leg, and lateral aspect of the foot. The sciatic nerve is the main nerve trunk that governs the lower extremities. Sciatica refers to pain in the sciatic nerve pathway and its distribution (hip, back of the thigh, posterior aspect of the calf, and lateral aspect of the foot). Sciatica is also a category of low back pain. Some of it is caused by lumbar protrusion and compression of the sciatic nerve.
Cause
Cause
The sciatic nerve is composed of the 5~3 nerve roots. According to the lesion site rooting and dry sciatica, the former more common root sciatica lesions located in the spinal canal, the most common cause of lumbar disc herniation, followed by intraspinal tumor, lumbar tuberculosis, lumbosacral radiculitis, etc. . The lesions of dry sciatica are mainly in the extraspinal sciatic nerve. The causes are sacral arthritis, pelvic tumor, uterine compression, hip trauma, piriformis syndrome, improper gluteal injection, and diabetes.
Examine
an examination
Related inspection
Limb height test, straight leg raising test, bowstring test, raszeg test
1. Imaging examination has an important position, including lumbosacral vertebrae, ankle X-ray, spinal MRI, myelography plus CT, in addition to clinical pelvic physical diagnosis can be done pelvic CT or MRI.
2. Electrophysiological examination: 1 EMG of the paravertebral muscle can help identify root sciatica and distal lesions. 2 EMG short head EMG can help identify the lateral sciatic nerve and common peroneal neuropathy. 3 Patients with pelvic or femoral fractures are difficult to perform routine physical examination, and EMG can help evaluate neurological function. The nerve conduction velocity and F wave of the 4 nerves and the common peroneal nerve may be abnormal, and the sciatic nerve conduction velocity is difficult to stimulate to the proximal end of the lesion.
3. Inject corticosteroids or local anesthetics into the piriformis, and if the pain is relieved, it will help diagnose the piriformis syndrome.
Diagnosis
Differential diagnosis
Neuralgia: Pain is one of the common symptoms of neurology. This kind of pain refers to the pain that is felt without external stimuli, also known as spontaneous pain. There are many types of spontaneous pain, and the lesions can be divided into peripheral neuropathic pain and central nervous pain. Severe pain: Pain is often a sign of a systemic disease or cancer. Especially when the elderly have severe pain, if the general drug can not be alleviated, it is likely to indicate that the elderly have a serious disease such as malignant tumor or tuberculosis.
"Trigeminal neuralgia" is a paroxysmal severe neuropathic pain that occurs repeatedly in the distribution of facial trigeminal nerves. In the area of the trigeminal nerve in the head and face, sudden onset, sudden arrest, lightning, knife cutting, burning Severe pain, unbearable, unbearable. Some people call this pain "the first pain in the world." Post-herpetic neuralgia: A neuropathic pain syndrome that occurs after infection with acute herpes zoster. Most patients with herpes zoster can be recovered after treatment, but some patients have pain in the damaged skin area after herpes has healed for more than 3 months, called post-herpetic neuralgia. 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 longer history of repeated low back pain, or heavy physical labor history, often in a lumbar injury or bending after the acute incidence of labor. In addition to the symptoms and signs of typical root sciatica, there are lumbar muscle spasm, limited lumbar motion and loss of anterior lumbar flexion. The intervertebral space of the disc herniation may have obvious tenderness and radiation pain. X-ray film can 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. The pain at night is obviously aggravated, and the course of the disease is progressively worse. There are also sphincter dysfunction and sensory loss in the saddle area. Lumbar puncture has subarachnoid obstruction and cerebrospinal fluid protein quantitatively 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 "intermittent claudication" in the early stage, pain in the lower extremities after walking, but the symptoms are reduced or disappeared after walking or resting. When the nerve root or cauda equina is severely stressed, symptoms and signs of sciatica on one or both sides may be present, and the course of the disease is progressively aggravated. Treatment such as bed rest or traction is ineffective. Lumbar sacral X-ray or CT can be diagnosed.
Fourth, lumbosacral radiculitis: due to infection, poisoning, nutritional metabolic disorders or strain, suffering from cold and other factors. Generally, the onset is more urgent, and the damage range often exceeds the area of the sciatic nerve. The whole lower limb weakness, pain, mild muscle atrophy, and the Achilles tendon reflex are often weakened or disappeared. In addition, it is also necessary to consider lumbar tuberculosis, vertebral metastases and the like. In the case of dry sciatica, attention should be paid to the history of cold or infection, as well as the ankle, hip, pelvis and buttocks. If necessary, in addition to lumbosacral X-ray, ankle X-ray can be performed. Photographs, anal fingers, gynecological examinations, and pelvic organs B-ultrasound were performed to determine the cause.
