Sciatica

Sciatica

1. pain that radiates from the lower lumbar spine to the buttock and down the back of the leg

   • back pain
     • Anatomy of back
       • Spine
         • Functional structure of the vertebral column
           • bones
             • Total of 33-34 vertebrae
               • 7 cervical
                 • have foramen transversarium
               • 12 thoracic
                 • have costal facets
               • 5 lumbar
               • 5 sacral pieces fused together
               • 2-5 coccygeal
             • typical characteristics are
               • body
                 • with going down the size of body increase
               • nuchal arch
                 • Spinous process
                 • 2 transverse processes
                 • 2 Superior articular processes
                 • 2 Inferior articular processes
           • ligaments
             • Anterior longitudinal ligament
             • Posterior longitudinal ligament
             • Intertransverse ligament
             • Ligamentum flavum
             • Interspinous ligaments
             • Supraspinous ligament
             • ligamentum nuchae
           • muscles
             • Superficial layer
               • connects vertebral column to upper limb
               • Superficial group
                 • Trapezius
                 • Latissimus Dorsi
               • Deep group
                 • Rhomboideus major
                 • Rhomboideus minor
                 • Levator scapulae
             • Intermediate layer
               • Serratus posterior superior
               • Serratus posterior inferior
               • respiratory muscles that insert into ribs
             • Deep layer
               • move the trunk and back
               • Splenius
               • Erector spinae
               • Transverso-spinalis
         • Functional structure of intervertebral disc
           • The main weight bearing part is the nucleus
           • Fibrocartilage prevent the nucleus to leak outside when compressed
           • secondary cartilaginous joint type
         • movements
           • Extension
           • Flexion
           • Rotation
           • Lateral flexion
     • common causes
       • Inflammation
       • Arthritis
       • Osteoporosis
       • Stress
       • Injured herniated and ruptured discs
       • Fibromyalgia
   • along the path of sciatic nerve
     • motor & sensory distibution
       • motor
         • directly innervates
           • Posterior compartment of thigh
           • Hamstring portion of the adductor magnus
         • indirectly innervates
           • with terminal branches
             • Tibial nerve
               • calf muscles
               • some of intrinsic muscles of foot
             • Common fibular nerve
               • muscles of the anterior leg
               • lateral leg
               • remaining intrinsic foot muscles
       • sensory
         • no direct sensory innervation
         • indirect sensory innervation
           • common fibular nerve part
             • skin of the lateral leg
             • dorsum of foot
           • Tibial nerve part
             • skin of the posterolateral leg
             • lateral foot
             • sole of the foot
     • the largest nerve in body
     • derived from sacral plexus

2. Lines of management

   • Non-surgical treatments
     • Physiotherapy
       • heat and cold therapy
       • TENS
       • Therapeutic ultrasound
     • Mindfulness
     • Diet
     • Injection-Based Treatment
     • Alternative Treatment
       • yoga
       • acupuncture
       • acupressure
       • biofeedback
     • Pharmacologic treatment
       • placebo effect
         • placebo is a medical treatment or procedure designed to deceive the participant of a clinical experiment
         • does not cure
           • just makes you feel better
   • Surgery
     • not preferred
     • but could be done in some situations

3. Diagnosis

   • Medical History
   • check symptoms
   • Physical Examination
   • Imaging studies
     • for confirmation
       • MRI
         • disk herniation
         • shows pressure on nerve
       • CT scan
     • X-ray
       • find
         • spinal fractures
         • tumor + bone spurs
         • disk problems
     • electromyography
       • examine how electrical impulses travel through sciatic nerve and response of muscles

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