Sciatica

Question 1

What is sciatica? whats it usually caused by?

Answer 1

1. Pain along sciatic nerve- lower back, through hips & buttocks and down each leg.
2. usually caused by herniated disc or spinal sternosis, Spondyloliesthesis & OA pressure on the disc

Question 2

Anatomy of sciatic nerve- pathway 4

Answer 2

largest nerve in humans

2. originates ventral rami of spinal nerves L4 to S3 & contain fibres from anterior and posterior divisions of lumbosacral plexus
3. nerve fibres form single nerve leave pelvis through greater sciatic foramen
4. goes down posterior thigh
5. before popliteal fossa divides into 2 branches- tibial nerve and common peroneal nerve

Question 3

functions of sciatic nerve 2

Answer 3

motor functions- eg. hip adduction, plantarflexion
sensory fiunctions- eg. sole of foot, web between 1st and 2nd toes

Question 4

sciatic nerve supply

Answer 4

undivided
- hamstrings
- adductor magnus
tibial branch
- L5-S3
common peroneal
- L4-S2

Question 5

dangers of sciatica 3

Answer 5

• if not treated- permanent damage
• more dangerous for diabetic as more susceptible to nerve damage
• can lead to CES damaging the nerve root

Question 6

testing for sciatica

Answer 6

1. Straight leg test- neuro pain in lower back and leg between 30-70° hip flexion- L4-S1 nerve root
2. Slump test
3. Myotomes L4- ankle dorsiflexion or get to walk on tip toes, L5- big toe extension, S1- ankle plantar flexion
4. reflexes - Patella L3-L4, Achilles L5-S1

Question 7

non invasive technique 3

Answer 7

1. NSAIDs
2. Opioids
3. Corticosteroids

Question 8

exercises 5

Answer 8

1. pelvic tilt
2. knee to chest
3. lower trunk rotations
4. bird dogs mgill- strengthen abdominal muscles stabilise lower back
5. Mckenzie

Question 9

imaging for sciatica

Answer 9

Scans arent normally needed
X-ray- see if there’s bone overgrowth compressing on nerve root
MRI- imaging to show disc compression and nerve

Question 10

symptoms of sciatica 6

Answer 10

bottom and back of legs through to feet and toes feel
- tingling
- weakness - myotomes
- numbness- dermatomes
- pain- stabbing
- positive SLR or slump test
- altered reflexes- patella & achilles
- potential foot drop

Question 11

L4, L5, S1 reactions sciatica

Answer 11

L4: pain, tingling and numbness in the thigh. weak when straightening the leg and may have a diminished knee jerk reflex.
L5: pain, tingling and numbness may extend to the foot and big toes.
S1: pain, tingling and numbness on the outer part of the foot. weakness when elevating the heel off the ground and standing on tiptoes. The ankle jerk reflex may be diminished.