Sciatica is a syndrome mainly caused by the sciatic nerve pathway and distribution area pain. Most cases of sciatica are secondary to sciatic nerve stimulation and compression and damage to the sciatic nerve and surrounding structures, called secondary sciatica; a few are primary, that is, sciatica.
The causes are many and varied. Sciatica in most patients is secondary to sciatic nerve stimulation and compression and damage to the sciatic nerve by local and surrounding structures, called secondary sciatica; a few are primary, that is, sciatica.
1. General symptoms
(1) The pain is mainly limited to the distribution area of the sciatic nerve, the back of the thigh, the posterior side of the calf and the foot. Patients with severe pain can assume a unique posture; waist flexion, knee flexion, and toe landing If the lesion is located in the nerve root, the pain will increase when the pressure in the spinal canal increases (coughing, exertion).
(2) The degree of muscle weakness can vary greatly depending on the cause, location of the disease, and degree of damage. There may be all or part of the sciatic nerve innervating muscles weak or paralyzed.
(3) With or without tenderness of the sciatic nerve trunk at the sciatic notch.
(4) There is sciatic nerve traction sign, Lasege sign and its allelic signs are positive, the existence of this sign is often parallel to the severity of pain. Local anesthesia of the sciatic nerve root or nerve trunk can disappear.
(5) The Achilles tendon reflex decreases or disappears, and the knee reflex may increase due to stimulation.
(6) There may be a decrease or disappearance of various sensations in the area innervated by the sciatic nerve, including a decrease in vibration sensation in the lateral malleolus, and there may also be very mild sensory disturbances.
2. Sciatic neuritis
Often accompanied by various types of infections and systemic diseases, such as upper respiratory tract infections. Because the sciatic nerve is relatively superficial, sciatic neuritis is prone to occur when damp or cold. When sciatic neuritis occurs in systemic diseases, attention should be paid to whether there are complications such as collagen disease and diabetes.
Sciatica is mostly unilateral, without lumbar and back pain. The pain is generally persistent or episodic. Symptoms aggravate when the pressure of the spinal canal increases, and it can also radiate along the path of the sciatic nerve. Sciatic nerve trunk tenderness is obvious, gastrocnemius tenderness exists; pain and muscle weakness are not parallel, generally, pain is heavier, and muscle weakness is not obvious, because it is difficult to judge motor function due to pain in the acute stage, foot drop, gastrocnemius, tibialis anterior muscle can be detected Atrophy; the Achilles tendon reflex is reduced or disappeared, but the Achilles tendon reflex can also be normal, the knee reflex is normal, and the superficial sensory disturbance is obvious.
3. Secondary sciatica
(1) Lumbar intervertebral disc herniation is the most common cause of sciatica. It mostly occurs in lumbar 4～5 and lumbar 5～sacral 1. About 1/3 of the cases have a history of acute lumbar trauma. Most patients are between 20 and 40 years old. It is characterized by low back pain for several weeks and months, and sciatica of the lower extremity. In addition to the general symptoms of sciatica, the physical examination also has tight back muscles, restricted lumbar movement, scoliosis, and tenderness of the spinous process at the lesion.
(2) Lumbar osteoarthropathy is more common in people over 40 years of age, subacute and chronic onset, often with a history of long-term low back pain, difficulty in standing for a long time, difficulty in standing for a long time, and difficulty in standing for a long time. It can be clinically manifested on one or both sides Symptoms of sciatica and waist.
(3) Congenital malformations of the lumbosacral spine. Lumbar sacralization, sacral lumbar sacralization, and recessive spina bifida. In addition to sciatica, the latter often has a history of enuresis, physical examination often has foot deformities, and lumbosacral skin abnormalities, such as The small depression behind the anus and the small hemangioma on the midline of the sacrum often objectively and accurately indicate the unhealed part of the lamina.
(4) Sacroiliac arthritis is common rheumatoid and tuberculosis. When the joint capsule is exuded and destroyed, it stimulates the 4 to 5 nerve trunks of the waist. Some patients may have symptoms of sciatica.
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