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.
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   . 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 .
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 . There may be a loss of sensations if the lesion involves the posterior aspect of the thigh and the foot . 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 . Injuries in the distal part of the nerve give rise to neurological deficits similar to those seen in other mononeuropathies or lumbosacral radiculopathies .
Entire Body System
- 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]
Conclusion Our patient, a 52-year-old man with a history of mild intermittent back pain, presented with significant lower extremity pain and weakness, out of character with his prior back pain exacerbations. [ncbi.nlm.nih.gov]
- Constitutional Symptom
He denied any constitutional symptoms. The patient had his first episode of back pain 16 years earlier, at which time he responded to a treatment of acupuncture and stretching. [ncbi.nlm.nih.gov]
- 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]
Past surgical history includes right finger soft tissue mass excision and hysterectomy. Medications include meloxicam and gabapentin. Physical examination revealed an alert and oriented female with a BMI of 25. Overall her pain was 6 out of 10. [faoj.org]
- 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]
Easy exercise program for low back pain relief 1. [slideshare.net]
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]
- Long Toes
Two months later, the patient's ankle dorsiflexion strength, measured with manual muscle test, was grade 0/0, long toe extension was grade 0/0, and ankle plantar flexion was grade 0/0. [journals.lww.com]
- 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]
However, arterial blood pressure was low (90/60 mmHg), CK levels were elevated (34,540 IU/L), and oliguria was evident. [journals.lww.com]
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 report. 61 Ko JU...Park D 30212953 2018 10 A Central Nervous System Tumor Mimicking a Lumbar Spine Pathology Causing Acute Foot Drop: A Case Report. 61 Dolev A...Yassin M 30740383 2018 11 Post-operative extra-spinal etiologies of sciatic nerve impingement [malacards.org]
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]
Pudendal neuralgia allows for PN to be classified, based on the entrapment site: type I, in the sciatic notch; type II, the ischial spine and sacrosciatic... [evidence.nhs.uk]
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]
These include the following: Trigeminal neuralgia. Pain following shingles ( postherpetic neuralgia ). Diabetic neuropathy - a nerve disorder that develops in some people with diabetes. [patient.co.uk]
A prescription patch of 8% capsaicin (Qutenza) is approved for the treatment of postherpetic neuralgia. [medicinenet.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]
- Altered Mental Status
Some time is due to abdominal aortic aneurysm with short infrarenal neck and aneurismal, unequal bilateral common iliac arteries after prolonged immobility secondary to an altered mental status (5-8). [jneuro.com]
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 . 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 . Motor unit amplitude, arrangement, and duration are useful to determine whether SN has been long-standing . 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 .
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  MRI can also help to detect other lesions like tumors.
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