Channel: nabil ebraheim

Category: Education

Tags: treatmentpainorthopaedicsdr. nabil ebraheimutmcbackdiagnosisrootslegsymptomssciaticanathan elkinssignsnervesciaticlumbar spinemanagmentut

Description: Dr. Ebraheim’s educational animated video describes the condition of Sciatica and its associated conditions. Follow me on twitter: twitter.com/#!/DrEbraheim_UTMC Find me on Instagram @OrthoInitiative Sciatica is shooting pain radiating along the course of the sciatic nerve which runs from the lower back to the buttocks through the back of the thigh, into the lower leg into the foot. Sciatica pain usually affects 1 side of the body and is sometimes called lumbar radiculopathy. Sciatica may be self diagnose by the pain shooting down the buttocks, the back of the thigh and the leg. Two of most common causes of sciatica: #1. Lumbar disc herniation #2. Piriformis syndrome Sciatica is one of the most common symptoms of lumbar disc herniation. Piriformis syndrome can cause sciatica-like symptoms and this needs to be differentiated from sciatica that is caused by a herniated disc. Both may have the same symptoms, but both have different causes! If there is a herniated disc affecting the lumbar nerve root, there will be irritation of the nerve root and this is called lumbar radiculopathy. Disc protrusion affecting the nerve root. The pain will be shooting down the thigh and into the leg which is true sciatica. Sitting may aggravate and irritate the nerve causing the sciatica pain because it places tension and will stretch the nerve during sitting. The nerve pain can be shooting pain like an electric shock that radiates to the leg and the foot. There may be burning, tingling, and numbness. The pain from sciatica may be constant and severe. Sudden movements, coughing, and sneezing can also aggravate the sciatic nerve and cause the pain. The pain improves when lying down, and the pain is worse during standing and sitting. The symptoms of sciatica is felt in different areas of the leg and the foot depending on where the nerve root component of the sciatic nerve is compressed in which nerve root is involved. Lumbar disc herniation As a disc ruptures and herniates, this irritates the nerve root. A tear in the disc is created and through this tear, the disc material (nucleus pulposus) will herniate and irritate the nerve root. The most commonly affected level is L5-S1, which will involve the S1 nerve root. The best examination for lumbar disc herniation is the straight leg raising sign (tension sign). If the patient has a positive straight leg raising sign (tension sign), this patient will get better with surgery. Straight leg raising sign (tension sign). There will be pain and paresthesia at 30 degrees and 70 degrees of leg elevation. This elevation will reproduce the leg pain but not the back pain. Lasegue’s Test The straight leg raising pain is aggravated by forced ankle dorsiflexion. The straight leg raising sign will usually diagnose L5 or S1 nerve root irritation. If the patient complains of sciatica and the MRI does not show that there is a disc problem, then the patient probably has piriformis syndrome. 90% of patients with disc herniation will improve within 1 month with nonoperative treatment such as: • Rest • Physical therapy • anti-inflammatory medication • Muscle relaxants The condition usually resolves itself in few weeks. When his surgery done? • When there is progressive weakness. • When there is persistent disabling pain for more than 6 weeks Who is a good candidate for surgery? A good surgical candidate will have: • Sciatica (leg pain, patient will complain of shooting pain into the back of the thigh and leg) • Tension sign (positive straight leg raise) • Abnormal neurological findings • MRI finding of disc herniation, which is consistent with the neurological examination (L5-S1 herniated disc will affect the S1 nerve root). What type of surgery? • Laminotomy and discectomy The surgical treatment is done to remove the intervertebral disc and relieve the pressure being placed on the nerve. Surgery is better and is quicker and recovery than no surgery. After surgery, the patient can return to intense activity after 4 to 6 weeks. Piriformis syndrome • The sciatic nerve can become irritated where it runs under the piriformis muscle in the buttock area. • When the piriformis muscle irritates the sciatic nerve, it causes sciatica. • This is not a true lumbar radiculopathy and it is not a true sciatica, however it is called sciatica. • Piriformis muscles pushing on the sciatic nerve. Diagnosis of piriformis syndrome should be done by exclusion of any possible spine problems, which could be compressing the spinal nerve roots and causing true sciatica! A true sciatica is caused from irritation of the nerve roots due to disc problems. Piriformis syndrome causes sciatica due to irritation of the sciatic nerve itself! Piriformis syndrome Treatment • Physical therapy • Anti-inflammatory medication • Injections • Surgery o Done as a last resort o Release of the cause of the problem (piriformis tendon) and exploration of the sciatic nerve if needed.