Sciatica/Lumbar Radiculopathy Flashcards
what can cause the nucleus pulposis to herniate/prolapse?
a disc tear can cause it to herniate through the tear
how can a prolapsed disc cause symptoms outside the spine?
disc material can impinge on an existing nerve root resulting in pain and altered sensation as well as reduced power
how are the symptoms of a prolapsed discs distributed?
pain and altered sensation = dermatomal (sensory)distribution
reduced power = myotomal distribution
how can a prolapsed disc affect reflexes?
can reduce them
what is the most common site for a disc to impinge on a nerve root?
L4, L5 and S1 nerve roots contributing to the sciatic nerve
where is the pain felt in sciatica and describe its character?
neuralgic burning/tingling pain
like a severe toothache radiating down the back of the thigh to below the knee
- Never below the knee
name 2 possible signs seen in sciatica
positive sciatic stretch test
can have a cross over sign where sciatic stretch testing of the opposite produces pain on the affected side
pattern seen in L3/L4 prolapse?
L4 root entrapment > pain down to medial ankle > loss of quadriceps power, reduced knee jerk
pattern seen in L4/L5 prolapse?
L5 root entrapment > pain down dorsum of foot, reduced power in extensor hallicus longus and tibialis anterior
pattern seen in L5/S1 prolapse?
S1 root entrapment > pain to sole of foot, reduced power of plantarflexion, reduced ankle jerk
does a certain level always produce the same pattern?
no
e.g a very lateral disc prolapse can cause impingement of the nerve root above instead of below
how is lumbar radiculopathy treated?
1st line = analgesia, exercise and physiotherapy
occasionally drugs for neuropathic pain used
discectomy surgery very occasionally indicated
