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]

  cramps, and weakness in the left lower extremity. [ncbi.nlm.nih.gov]

• Weight Gain

  For example, if weight gain is the underlying cause, then a weight loss program is the most appropriate treatment. Compression neuropathy occurring in pregnancy often resolves after delivery, so no specific treatment is usually required. [en.wikipedia.org]

• Fecal Incontinence

  Stent-graft of an abdominal aortic aneurysm with embolization of iliac arteries was complicated by lower extremity weakness and fecal incontinence in one patient [ 8 ]. [jbppni.biomedcentral.com]

• Blister

  To help prevent peripheral neuropathy: Check your feet and legs daily -- look for blisters, calluses, and cuts. Apply lotion if your feet are dry, but avoid getting lotion in between your toes; this area should be kept dry. [webmd.com]

  Diagnosis typically involves electromyography and lumbar puncture. [11] Shingles is more common among the elderly and immunocompromised; usually (but not always) pain is followed by appearance of a rash with small blisters along a single dermatome. [11 [en.wikipedia.org]

• Flushing

  NCT00009672 Phase 2 Nortriptyline;Morphine 29 A Comparative Effectiveness Randomised Placebo Controlled Pilot Trial of the Management of Acute Lumbar Radicular Pain Recruiting NCT03240783 Phase 2 Betamethasone OR Dexamethasone Injectable;Normal Saline Flush [malacards.org]

• Low Back Pain

  She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. [ncbi.nlm.nih.gov]

  Easy exercise program for low back pain relief <ul><li>1. [slideshare.net]

  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]

  American Association of Neurological Surgeons: "Low Back Pain." American Pregnancy Association: "Pregnancy and Sciatic Nerve Pain." American College of Obstetricians and Gynecologists: "You and Your Baby." [webmd.com]

  A guide to buttock and leg pain (which may or may not involve the sciatic nerve) If you mainly have low back pain, please change articles: you need to be reading Save Yourself from Low Back Pain! [painscience.com]

• Leg Pain

  To describe 4 patients presenting with radiating leg pain due to sciatic nerve involvement, all with a vascular etiology. Four patients presenting with neuropathic pain were retrospectively reviewed. [ncbi.nlm.nih.gov]

  Photo Source: Shutterstock.Sciatic nerve pain can travel from the buttock area, down the back of the thigh, and into the leg. Leg pain is the classic hallmark of sciatica. [spineuniverse.com]

  You’ve heard other people talk about this weird leg pain — and now, joy, you’ve got mystery leg pain of your own. Is it sciatica? Spine expert Santhosh Thomas, DO, MBA explains what it is, how to tell if you have it — and how to get relief. [health.clevelandclinic.org]

  The most common pain associated with sciatica is pain moving from the lower back, through the buttock and down the back of the leg. [neuropathytreatmentgroup.com]

• Contusion

  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]

  […] immediate, but rather it develops over time Severe pain Neuropathy progresses Different anatomical distribution than expected “We know new or worsened weakness after hip surgery can be attributed to surgical factors, such as stretching, compression, contusion [newsnetwork.mayoclinic.org]

• Hip Dislocation

  Traumatic injuries may include injury to sciatic nerve in association with femur fracture, hip dislocation or fracture, laceration, gunshot wound and posterior compartman syndrome in thigh. [scopemed.org]

  Etiologies of these 73 cases 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 causes (16.4%). [ncbi.nlm.nih.gov]

• Joint Dislocation

   ❐ Researchers dislocated neck joints in corpses to measure the effect on the size of the intervertebral foramina. (Interesting chore!) [painscience.com]

• Incontinence

  Search: Home Bath Safety Braces Impotence & Male ED Incontinence Mobility Shop By Categories Shop by Topic Gift Ideas Respiratory Miscellaneous Home Bath Safety Bath Lifts Bathing Aids - Hygiene Bidet Toilet Seats Commodes and Accessories Grab Bars Shower [activeforever.com]

  It can in certain cases, even result in bladder or bowel incontinence. Return from Sciatica back to Trauma [livingwithperipheralneuropathy.com]

  Decrease in number of orgasms or lack of orgasm Treatments may include: Counseling Estrogen Vaginal creams Lubricants Symptoms of neuropathy of the urinary system may include: Unable to completely empty bladder Increased urinary tract infections Bloating Incontinence [webmd.com]

  Stent-graft of an abdominal aortic aneurysm with embolization of iliac arteries was complicated by lower extremity weakness and fecal incontinence in one patient [ 8 ]. [jbppni.biomedcentral.com]

  Bowel and bladder incontinence can rarely occur and clinically mimic cauda equina syndrome. The imaging features of lumbosacral plexopathy depend on the underlying process. [pubs.rsna.org]

• 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

  Overview Sciatic neuropathy is an important consideration in the patient with foot drop. [medlink.com]

  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]

• 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]

  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]

  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]

• Stupor

  Stayng in the lotus position for a long time in a drunken stupor can damage the sciatic nerve bilaterally. Key Words: Sciatic neuropathy, Lotus position, Nerve compression syndromes [jkna.org]

  She was admitted to hospital with stupor (Glasgow Coma Scale score = 8) 4 hours after ingestion of approximately 40 tablets (total of 3 g) without signs of trauma. She did not take any other medication in this attempted suicide. [journals.lww.com]

• Trigeminal Neuralgia

  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]

  Headaches can also result from sinusitis, trigeminal neuralgia, giant cell arteritis, or brain tumors. The treatment of the various kinds of headaches varies depending on the kind of headache and the severity of the pain. [emedicinehealth.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 [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.

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]

Treatment options of sciatic nerve neuropathy (neuritis) chosen individually in each case. [minclinic.ru]

Treatment The immediate treatment of most cases of sciatica is to recommend medications specific to the inflammation. Staying active is also highly recommended, while avoiding activities that put pressure on the back. [encyclopedia.com]

- Nerve Palsy Associated with Total Hip Arthroplasty - The frequency, prognosis and significance of nerve injuries in total hip arthroplasty - females seem to be at significantly higher risk; - sciatic and superior gluteal nerve and vessels course opposite [wheelessonline.com]

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]

Key words Sciatic neuropathy, compartment syndrome, electrophysiological studies, prognosis. Introduction Sciatic neuropathy is an uncommonly diagnosed focal mononeuropathy. [jneuro.com]

Unexpectedly, PNB was the third most common etiology (16%, n = 7). 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]

In this update, the authors summarize the clinical, etiologic, diagnostic, and management issues regarding sciatic neuropathy. [medlink.com]

Etiologies of sciatic neuropathy may include traumatic, compressive, ischemic, neoplastic or idiopathic factors. [scopemed.org]

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]

Guidance on the management of pain in older people This guidance reviews the epidemiology and management of pain in older people via a literature review of published research. [evidence.nhs.uk]

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]

We describe a patient who developed post-radiation sciatic neuropathy after approximately 3 years and discuss the pathophysiology, clinical course and treatment options available for the deleterious effects of radiation to peripheral nerves. [ncbi.nlm.nih.gov]

This article reviews the anatomy, clinical features, pathophysiology, and electrodiagnostic assessment of sciatic neuropathies. [semanticscholar.org]

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]

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]

The pathophysiology of neuropathic pain is so complicated that it is not fully understood [4]. Neuropathic pain may develop because of sciatic nerve injury. [hindawi.com]

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]

Prevention of Hepatitis A Through Active or Passive Immunization 19 May 2006 - Publisher: Centers for Disease Control and Prevention Routine vaccination of children is an effective way to reduce hepatitis A incidence in the United States. [evidence.nhs.uk]

Shingles can cause peripheral neuropathy, but the vaccine can prevent more than 95% of shingles cases. [es.aurorahealthcare.org]

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]

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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