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Sciatic Neuropathy

Sciatic Nerve Injuries

Sciatic neuropathy is a mononeuropathy caused by damage to the sciatic nerve following trauma, hematoma, injections, compression or surgical complications. Consequently, symptoms such as pain, paresthesias, and neurological deficits can develop. Electromyography and nerve conduction studies help in diagnosis and provide prognostic information.


Presentation

Sciatic neuropathy (SN) is a result of nerve injury or compression anywhere along the route of the nerve from the lumbosacral region to its bifurcation in the posterior aspect of the thigh. Accidental (hip fracture, dislocation, penetrating wounds) or iatrogenic (intramuscular injections) trauma, tumors, ischemia, and compression (hematomas, compression syndrome) can cause this condition [1] [2] [3]. Piriformis syndrome is another rare etiologic factor of SN. As compression neuropathy is seen during pregnancy, prolonged lithotomy position can lead to piriformis syndrome and consequently SN [4].

Patients with SN typically present with lower extremity pain and paresthesias. Other symptoms depend on the level at which the sciatic nerve is affected. If the lesion is proximal then genuflexion is difficult, with a loss of foot dorsiflexion (flail foot), and plantarflexion [3]. There may be a loss of sensations if the lesion involves the posterior aspect of the thigh and the foot [3]. Patients may be able to flex and extend their knee in hamstring sparring injuries of the nerve, although their gait will be impaired by their inability to plantarflex and dorsiflex [3]. Injuries in the distal part of the nerve give rise to neurological deficits similar to those seen in other mononeuropathies or lumbosacral radiculopathies [5].

Children, when suffering from SN, present with weakness of the tibialis anterior and gastrocnemius muscles [6]. However, SN occurs rarely in this age group.

Lower Extremity Pain
  • Patients with SN typically present with lower extremity pain and paresthesias. Other symptoms depend on the level at which the sciatic nerve is affected.[symptoma.com]
  • Lumbosacral plexopathies caused by neoplasms often present with back, hip or buttocks pain, while other causes often present with lower extremity pain 1 .[now.aapmr.org]
Soft Tissue Mass
  • We describe an unusual case in which a patient underwent surgical excision of a large soft-tissue mass on his right side that involved the posterior and medial compartment of the thigh with displacement of the sciatic nerve posteriorly.[ncbi.nlm.nih.gov]
Prolonged Immobilization
  • Less common causes include piriformis syndrome, primary tumors of the sciatic nerve, metastatic tumors invading or compressing the nerve, endometriosis, vascular malformations, and prolonged immobilization or positioning.[ncbi.nlm.nih.gov]
Thrombosis
  • Thrombosis, distal embolization, aneurysmal dilatation, and rupture of this vessel with compression of the sciatic nerve have been recorded.[ncbi.nlm.nih.gov]
  • The diagnosis of sciatic neuropathy caused by deep vein thrombosis is extremely rare; however, it should be considered in the differential diagnosis of unilateral lower extremity weakness in patients recovering from intensive care.[ncbi.nlm.nih.gov]
  • Absolute ethanol is toxic to vascular endothelium, inducing thrombosis in affected vessels. [ 3 ] Delivery of the agent to the nidus of the lesion is essential in reducing systemic side effects, such as pulmonary hypertension. [ 1 ] Catheter-guided techniques[jbppni.biomedcentral.com]
  • Deep venous thrombosis can be prevented with serial compression devices, which may need to be placed on the upper extremities when both legs need to be approached to harvest the sural nerves for grafting.[emedicine.medscape.com]
Low Back Pain
  • We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling.[ncbi.nlm.nih.gov]
  • He complained of low back pain, left buttock pain, and left leg numbness and weakness. The left hamstring, anterior tibial, and gastrocnemius muscles were markedly weak (0-1/5).[jamanetwork.com]
  • Back Pain: How to Relieve Low Back Pain and Sciatica. New York : W. W. Norton & Company, 1999. OTHER National Library of Medicine. "Sciatica." MEDLINE plus. (February 11, 2004). . ORGANIZATIONS American Chronic Pain Association (ACPA). P.O.[encyclopedia.com]
  • Back Pain: How to Relieve Low Back Pain and Sciatica. New York : W. W. Norton & Company, 1999. OTHER National Library of Medicine. "Sciatica." MEDLINE plus. (February 11, 2004).. ORGANIZATIONS American Chronic Pain Association (ACPA). P.O.[encyclopedia.com]
  • While sciatica is often associated with lower back pain ( lumbago ), it can be present without low back pain . Severe sciatica can make walking difficult if not impossible.[medicinenet.com]
Suggestibility
  • While the most reliable diagnostic and prognostic methods include nerve conduction studies and electromyography, magnetic resonance imaging has been suggested as an alternative method of determining type of lesion, establishing location, and investigating[ncbi.nlm.nih.gov]
  • Resolution of the intrapelvic portion of the mass was demonstrated on follow-up CT scan, suggesting that retroperitoneal resection of this type of lesion may not be required at the time of revision of the components.[ncbi.nlm.nih.gov]
  • This case suggests that these may be rare complications of TKA.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Our results suggest PNB is a relatively common etiology of sciatic neuropathy and is an important consideration in the differential diagnosis.[ncbi.nlm.nih.gov]
  • This report suggests that irritation and injury of spinal nerves can be the presenting signs in septic sacroiliitis.[ncbi.nlm.nih.gov]
Enlarged Uterus
  • A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen.[ncbi.nlm.nih.gov]
Sciatica
  • Here are a few common causes for sciatica: Spinal disc herniation is present in nearly 90% of all sciatica cases. This occurs when the herniated disc is pressing on a lumbar nerve.[neuropathytreatmentgroup.com]
  • Prognosis The prognosis for the pain relief of most cases of sciatica is excellent. With a combined use of anti-inflammatory drugs and mild exercise, such as walking, sciatica can be reduced and even eliminated.[encyclopedia.com]
Foot Drop
  • Pain and weakness, primarily foot drop, were the most common presenting symptoms.[ncbi.nlm.nih.gov]
  • CASE: A parturient complained of left foot drop after cesarean delivery for twins performed under spinal anesthesia.[ncbi.nlm.nih.gov]
  • Physical examination revealed loss of sensation and foot drop in the right foot.[ncbi.nlm.nih.gov]
  • August 30, 2016 ; 87 (9) Neuro Images Segmental fractional anisotropy analysis to disclose neurapraxia Yeonji Yoo , Sung Jun Kim , Jeehae Oh First published August 29, 2016, DOI: A 32-year-old woman presented with a left foot drop for 2 weeks after Caesarean[n.neurology.org]
  • Overview Sciatic neuropathy is an important consideration in the patient with foot drop.[medlink.com]
Neuralgia
  • What is sciatic neuralgia? Sciatic neuropathy is characterized by pain radiating from the back into the buttock and into the leg along the course of the sciatic nerve.[patientslikeme.com]
  • Synonym(s): sciatic neuralgia , sciatic neuritis [see sciatic] sciatic neuritis See sciatica . sciatic neuritis Inflammation of the sciatic nerve. See: sciatica See also: neuritis[medical-dictionary.thefreedictionary.com]
  • A prescription patch of 8% capsaicin (Qutenza) is approved for the treatment of postherpetic neuralgia.[medicinenet.com]
  • […] elsewhere classified ( R00 - R94 ) Diseases of the nervous system G50-G59 2019 ICD-10-CM Range G50-G59 Nerve, nerve root and plexus disorders Type 1 Excludes current traumatic nerve, nerve root and plexus disorders - see Injury, nerve by body region neuralgia[icd10data.com]

Workup

SN workup includes a detailed history along with a thorough clinical and neurological examination which will reveal a weakness of the tibialis anterior and/or gastrocnemius muscle. It is important to differentiate between SN, radiculopathies, and plexopathies as they all present with identical symptoms.

However electrodiagnostic tests such as electromyography and nerve conduction velocity test (NCV) are necessary to confirm the diagnosis and to provide information regarding prognosis [7]. They are also useful if the examination findings are inconclusive or if sensory deficits cannot be elicited e.g. in children. NCV are normal in radiculopathies but altered or abnormal in SN [5]. Motor unit amplitude, arrangement, and duration are useful to determine whether SN has been long-standing [5]. For the diagnosis of SN in children, electrophysiologic findings along the peroneal as well as the tibial and sural nerve distribution should be performed with or without electromyography in the muscles innervated by the tibial nerve [6].

Magnetic resonance imaging (MRI) or neurography and ultrasonography are some of the radiological tests performed in the workup of SN. Neuropathy findings on MRI include expansion of the nerve with variation in its course and elevated signal intensity and contrast enhancement. In patients with sciatic nerve compression, there may be edema in the vicinity of the nerve around the ischial tuberosity [8] MRI can also help to detect other lesions like tumors.

Treatment

  • The patient was transferred to the department of gastroenterology for the treatment of toxic hepatitis, which occurred during her inpatient treatment.[ncbi.nlm.nih.gov]
  • Three children died from the cancer or complications of treatment. One child with perineurioma remained clinically stable, and two children improved after treatment of their neoplasm. Copyright 2011 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • Treatment options of sciatic nerve neuropathy (neuritis) chosen individually in each case.[minclinic.ru]
  • Treatment The treatment of this condition includes symptomatic treatments to control the pain with nerve-pain pills like gabapentin, amitriptyline, pregabalin etc, and some patients may require more aggressive treatments like surgical decompression of[your-neurologist.com]
  • Treatment Depending on the cause for your sciatica, treatment options may vary.[neuropathytreatmentgroup.com]

Prognosis

  • The prognosis for sciatic nerve recovery was good among children who survived their associated cancer. Three children died from the cancer or complications of treatment.[ncbi.nlm.nih.gov]
  • LESSON: Patients presenting with peripheral neuropathy secondary to carbon monoxide intoxication may show variable recovery periods; however, a favorable prognosis can be expected regardless of the concomitant occurrence of rhabdomyolysis and/or compartment[ncbi.nlm.nih.gov]
  • Abstract We examined the clinical features of patients with sciatic neuropathy and the factors that influence prognosis.[ncbi.nlm.nih.gov]
  • Key words Sciatic neuropathy, compartment syndrome, electrophysiological studies, prognosis. Introduction Sciatic neuropathy is an uncommonly diagnosed focal mononeuropathy .[jneuro.com]
  • However electrodiagnostic tests such as electromyography and nerve conduction velocity test (NCV) are necessary to confirm the diagnosis and to provide information regarding prognosis.[symptoma.com]

Etiology

  • Unexpectedly, PNB was the third most common etiology (16%, n 7). CONCLUSIONS: Our results suggest PNB is a relatively common etiology of sciatic neuropathy and is an important consideration in the differential diagnosis.[ncbi.nlm.nih.gov]
  • Etiologies of sciatic neuropathy outside the neural foramina are uncommon. OBJECTIVE: To describe 4 patients presenting with radiating leg pain due to sciatic nerve involvement, all with a vascular etiology.[ncbi.nlm.nih.gov]
  • The etiologies included hip arthroplasty (21.9%), acute external compression (13.7%), infarction (9.6%), gunshot wound (9.6%), hip fracture/dislocation (9.6%), femur fracture (4.1%), contusion (4.1%), and uncertain (16.4%).[ncbi.nlm.nih.gov]
  • Etiologies of sciatic neuropathy may include traumatic, compressive, ischemic, neoplastic or idiopathic factors.[scopemed.org]
  • Piriformis syndrome is another rare etiologic factor of SN. As compression neuropathy is seen during pregnancy, prolonged lithotomy position can lead to piriformis syndrome and consequently SN.[symptoma.com]

Epidemiology

  • Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty[amjorthopedics.com]
  • Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-62.[spine-health.com]
  • Epidemiology [ 3 ] An incidence has been estimated at 4.3 per 10,000 person years. It occurs most commonly in people between the ages of 30 to 40 years. The condition is thought to be much rarer in children.[patient.info]
  • […] internus, with its gemelli, quadratus femoris and descends on adductor magnus.The sciatic divides into its terminal branches, the tibial and common peroneal nerves, usually just below the mid-thigh, although a higher division is not uncommon. [6] [7] Epidemiology[physio-pedia.com]
Sex distribution
Age distribution

Pathophysiology

  • This article reviews the anatomy, clinical features, pathophysiology, and electrodiagnostic assessment of sciatic neuropathies.[semanticscholar.org]
  • The acuity and severity of the lesion are consistent with either of these pathophysiologies. The sciatic nerve is supplied by vessels ultimately derived from the internal iliac artery.[jbppni.biomedcentral.com]
  • Pathophysiology [ edit ] External pressure reduces flow in the vessels supplying the nerve with blood (the vasa nervorum ). This causes local ischaemia, which has an immediate effect on the ability of the nerve axons to transmit action potentials.[en.wikipedia.org]
  • “Diabetic and Nondiabetic Lumbosacral Radiculoplexus Neuropathies: New Insights into Pathophysiology and Treatment.” Muscle & Nerve. 4 (2002): 477-491. Dyck, PJB, et al.[now.aapmr.org]

Prevention

  • CONCLUSION: A heightened awareness of sciatic nerve injury during prolonged surgery in the sitting position may make early diagnosis possible and allow prevention of further neurologic injury.[ncbi.nlm.nih.gov]
  • To prevent neuropathy, aggressive treatment of the pressure ulcer is necessary.[ncbi.nlm.nih.gov]
  • What makes it last longer is not entirely understood, but researchers suspect that stress, mood changes, and the fear of further injury may prevent patients from being active and exacerbate the pain.[dramandakiliandctulsa.com]
  • More in this TOC Section Pathogenesis of Diabetic Vascular Disease: Evidence for the Role of Reduced Heparan Sulfate Proteoglycan Metabolic and Vascular Factors in the Pathogenesis of Diabetic Neuropathy The Role of Nutritional Modifications in the Prevention[diabetes.diabetesjournals.org]
  • Relief Parkinsons Pediatrics & Maternity Physical Therapy Skin Care Winter Products Oxygen Hospital Supplies Shop by Topic Arthritis Pain Relief Assistive Technology Care for Your Feet Carpal Tunnel Syndrome Diet and Nutrition Emergency Supplies Fall Prevention[activeforever.com]

References

Article

  1. Yuen EC, So YT. Entrapment and other focal neuropathies: sciatic neuropathy. Neurol Clin. 1999; 17(3):617–631
  2. Plewnia C, Wallace C, Zochodne D. Traumatic sciatic neuropathy: a novel cause, local experience and a review of the literature. J Trauma. 1999;47(5):986–999
  3. Kim DH, Murovic JA, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg. 2004; 101:8–17
  4. Altintaş A, Gündüz A, Kantarci F, Gözübatık Çelik G, Koçer N, Kızıltan ME. Sciatic neuropathy developed after injection during curettage. Agri. 2016;28(1):46–48
  5. Feinberg J, Sethi S. Sciatic Neuropathy: Case Report and Discussion of the Literature on Postoperative Sciatic Neuropathy and Sciatic Nerve Tumors. HSS J. 2006 Sep; 2(2): 181–187
  6. Srinivasan J, Ryan MM, Escolar DM, et al. Pediatric sciatic neuropathies.Neurology. 2011 Mar 15; 76(11): 976–980
  7. Kimura J. Peripheral nerve diseases. Amsterdam. Elsevier; 2006
  8. Mumby DM, Hartsilver EL. Magnetic resonance imaging of sciatic nerve compression injury after epidural blockade. Int J Obstet Anesth. 2012;21(2):199–200

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Last updated: 2018-06-22 05:40