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Symptoms and diagnosis of Sciatica
Sciatica which is a symptom produced due to inlammation or compression of the sciatic nerve. There are various causes of sciatica and the risk factors involved are ageing and immobility which is detailed here at
Risk factors and causes of sciatica.
The symptoms or clinical features of sciatica is based on the basic pathology of the involvement of sciatic nerve.
Features of sciatica
Sciatica presents with pain in the lower back radiating to thighs and calf muscles. There may be tingling, numbness along the path of the nerve root of sciatic nerve. Muscle weakness is not a feature but there may be a needle prick sensation sometimes on the toes.
In severe cases the lower end of the spinal cord may be compressed causing cauda equina syndrome which is a medical emergency as it involves bowel and bladder. Though this feature is out of context of sciatica.
Diagnosis of sciatica
A thorough physical examination is required for the diagnosis of sciatica. The strength of the muscles may be intact but the pain will aggravate in squatting position and may even be worse when one stand up from a squatting position. Walking on heel or toes may aggravate pain. The straight leg raise (SLR) test may be positive. An SLR test is done by lying the patient on back and then asked to raise his leg straight and if there is cruciating pain, means the test is positive.
Though for the diagnosis of sciatica a physical examination is sufficient but as it is a known fact that the underlying cause of sciatica is different a thorough investigation is required for diagnosisn the cause. These investigations are :-
X ray of spine in sciatica
An X ray of the spine can be helpful in diagnosing spondylolisthesis where there may be displacement of one vertebra over the other below it and is most commonly of L5 over S1. Other degenerative diseases like osteoarthritis which can lead to spinal canal stenosis can be detected by X Ray. Some spinal tumors or other tumor which can compress the spinal cord can be detected by spinal x ray.
CT scan of spine in sciatica
A CT scan of spinal cord is done mainly spinal myelogram and may be useful in detecting tumors or any comression of the spinal cord. The CT scan produces a cross sectional image of the spinal cord and is a better parameter for detecting spinal diseases which can lead to sciatica.
MRI of the spine in sciatica
For brain CT scan may be the ideal investigation, but for spine MRI is considered as the most sensitive test to detect any spinal abnormalities. Any injury to the spinal cord, or tumor or any degenerative disease of the spine can be detected by MRI most accurately. It is a non invasive but expensive test but for spinal problems in chronic sciatic pain an MRI is a must.
Thus for sciatica a physical examination is done carefully and thoroughly and to diagnose the cause an X Ray , CT scan and MRI are the diagnostic investigations.
Treatment of sciatica is mainly symptomatic but may require invasive procedure in severe case. The detail is given at
Treatment and complication of sciatica
There are various modes of prevention at the point of risk factors and detail should be referred at
Prevention of sciatica
One may try some unconventional mode of treatment which is emerging now a days and is equally effective and for this you may refer to
alternative approach for treatment of sciatica.
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Causes of sciatica and risk factors associated with it
Conventional treatment of sciatica and complications
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