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Sciatica

Sciatica. Pain along sciatic nerve. 2Irritation along any part of the sacral plexus, sciatic nerve trunk, or peripheral nerve branches. 2Irritation of peripheral nerve endings may cause pain reflex. 2Two lesions commonly to blame:Sacroiliac region 2Level of the piriformis muscle where nerve tr

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Sciatica

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    1. Sciatica Kelley McDonald Evaluation 1 2/18/08

    2. Sciatica Pain along sciatic nerve. 2 Irritation along any part of the sacral plexus, sciatic nerve trunk, or peripheral nerve branches. 2 Irritation of peripheral nerve endings may cause pain reflex. 2 Two lesions commonly to blame: Sacroiliac region 2 Level of the piriformis muscle where nerve trunk emerges through sciatic notch 2 Can be classified into four levels of severity 3

    3. Classifications Sciatica Only3 : No sensory/ muscle weakness Modify activity, develop rehab/prevention program An increase in pain would require re-evaluation. Sciatica with Soft Signs3 : Some sensory changes No or mild reflex change Normal muscle strength Normal bowel/bladder function Remove for 6 to 12 weeks

    4. Classifications Contd. Sciatica with Hard Signs3 : Sensory/reflex changes Muscle weakness due to repeated, chronic, or acute condition Normal bowel/bladder functions Remove 12 to 24 weeks Sciatica with Severe Signs3 : Sensory/reflex changes Muscle weakness Altered bladder function Immediate surgical decompression

    5. Sciatica Facts Can be caused by: Herniated intervertebral disk 4 Osteoarthritis of lower spine 4 Pregnant uterus 4 Dislocation of hip 4 Improper injections of buttocks 4 Sitting on hard surfaces for extended periods 4 Males can develop sciatica from constantly sitting on wallet carried in hip pocket. 4

    6. Causes Cysts 1 Nerve may be injured. 1 Spinal Stenosis 1 Inflammation of nerve root 1 Scar tissue 1 SI joint dysfunction 1 L disc herniation 1 May be in connection with infection or inflammatory disease. 2 May be caused by mechanical factor of compression or tension. 2 Herniated disc 3 Annular tear 3 Myogenic/ Muscle-related disease 3 Facet joint arthropathy 3

    7. Signs & Symptoms High steppage 1 Inability to stand on toes or heels 1 Sensory difficulties throughout the foot 1 Muscle atrophy and/or weakness 1 Burning or hyperesthesia is sacral and/or gluteus area 1 Medial rotation with hip extension makes worse 1 Radiating pain 1 NCV tests slow 1 Pain extending down post. thigh and low leg to sole of foot and along lat. aspect of low leg 2 Pain when sitting/leaning forward 3

    8. Signs & Symptoms Contd. Morning pain 3 Arthritic pain (changes in weather aggravate) 3 Straight leg raising test aggravates 3 Pain into buttock/thigh region 3 Pain during IR of thigh/ spinal extension 3

    9. Special Test Straight leg raising test5 Pt. is lying supine. AT lifts leg while supporting foot at calcaneous. Knee should remain straight. The angle the leg can be raised will vary but normal range is 80. If pain is present during leg raise, then you must determine if pain is because of hamstring tightness or if it is actually the sciatic nerve. (+) Sign: Pain Indication: Reproduce back and leg pain so cause can be determined.

    10. Special Tests Well Leg Straight Leg Raising Test/ Opposite Leg/ Positive Cross Leg Straight Leg Raising Test5 Pt. lies supine while raising uninvolved leg. Pt. will experience pain in involved side. (+) Sign: Pain Indication: Evidence of space-occupying lesion such as a herniated disc in lumbar area.

    11. Special Tests Hoover Test 5 Have pt. perform in conjunction to straight leg raising test. Pt. laying supine. As pt. tries to raise leg, cup calcaneus of opposite leg. (+) Sign: Pt. pushed down on cupped heal as they try to raise leg. Indication: To see if pt. is genuinely trying to perform test or just malingering.

    12. Special Tests Kernig Test/ Brudzinski-Kernig Test Pt. positioned supine, hands behind head in cupped position. Pt. should flex head onto chest. While raises the extended leg actively by flexing hip until pain is present. Pt. should then flex knee and if pain disappears, test is positive. 1 (+) Sign: pain 1 Indication: Meningeal irritation, nerve root involvement, or possible irritation of dural coverings of nerve root. 5

    13. Special Test Bowstring Test 1 Perform SLR test, then flex K slightly to reduce symptoms. If thumb or finger pressure is applied to popliteal area, pain is present. (+) Sign: Pain Indication: Tension/pressure on sciatic nerve and modification for SLR test

    14. Resources 1. Yvettes PowerPoint 2. Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., Romani, W. A. (2005). Mucles: Testing and Function with Posture and Pain 5th Edition. Baltimore, MD: Lippincott Williams & Wilkins. 3. Anderson, M. K., Hall, S. J., Martin, M. (2005). Foundations of Athletic Training: Prevention, Assessment, and Management. Philadelphia, PA: Lippincott Williams & Wilkins. 4. Saladin, K. S. (2007). Anatomy & Physiology: The Unity of Form and Function. New York, NY: McGraw-Hill. 5. Hoppenfeld, S. (1976). Physical Examination of the Spine & Extremities. Upper Saddle River, NJ: Prentince Hall.

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