Week 3 - Sciatica/Lumbar Radiculopathy

Question 1

how can a disc prolapse occur?

Answer 1

if a disc tear occurs in the annulus fibrosis, the gelatinous nucleus pulposis can herniate/prolapse through the tear

Question 2

what can a disc prolapse cause?

Answer 2

disc material can impinge on an exiting nerve root resulting in pain and altered sensation in a dermatomal distribution as well as reduced muscle power in a myotomal distribution
can also reduce reflexes

Question 3

where is the commonest site for this to occur and what is this known as?

Answer 3

L4, L5 and S1 nerve roots

called sciatica

Question 4

describe sciatica pain

Answer 4

radicular pain felt as a neuralgic burning or severe tingling pain radiating down back of the thigh to below the knee

Question 5

name a test which is positive for sciatica?

Answer 5

sciatic stretch test

can have cross over sign where sciatic stretch testing of opposite side gives pain on the other side

Question 6

how is sciatica treated?

Answer 6

analgesia, mobility and physiotherapy
occasionally drugs for neuropathic pain (gabapentin)
very occasionally discectomy is indicated