Causes and symptoms of sciatica

The Sciatic nerve is the longest in the human body. In its composition it has sensory and motor fibers. Inflammation in this nerve – sciatica, symptoms of which are manifold, but the main one is pain. Why is this disease and how to treat it?

ICD-10

According to the ICD-10 disease refers to the class XIII (diseases of the musculoskeletal system). In this class of disease under "Dorsopathies Other dorsopathies (M50-M54)". M54 – Dorsalgia, code disease in ICD-10 – 54,3. Pathology associated with lesions of the intervertebral disc – ICD code – 51.1. The defeat of the sciatic nerve except for these reasons 57.0 G is encoded.

Etiology

sciatic nerve Lesions may be associated with the following pathologies:

• herniated disc
• back pain, including osteoarthritis spondylogenic;
• spondylolisthesis, spondylosis as a manifestation of intervertebral osteochondrosis;
• carpal tunnel syndrome
• infectious disease
• tumours
• postinjection complications (with the introduction of drugs in the gluteal region)
• trauma
• toxicity.

In the classical sense is called sciatica the sciatic nerve lesions due to degenerative diseases of spine (osteochondrosis and its neurological manifestations, vertebral sciatica), in the people this pathology is often called a pinched sciatic nerve. This is the most common cause of inflammation of the sciatic nerve (neuritis, sciatica).

triggers

• hypothermia
• pregnancy
• excessive physical exertion, injuries, overexertion of muscles of the gluteal, lumbar region, hips;
• prolonged constipation.

Symptoms

Pain is the main symptom of sciatica, whereas other manifestations may be absent at all. The pain may be cutting, burning or shooting. It affects mainly the thigh and buttocks, more rarely may extend to the lower leg and the lower back. Duration of pain of various or in the form of attacks. The intensity also depends on the aetiology and the individual patient.

The figures below show the localization of pain and additional symptoms depending on which spine is involved in the pathological process.

Other symptoms

In Addition to pain, patients may suffer other symptoms, usually have one or more of the following, often absent.

1. Disorders of reflexes (reduction, precipitation), which are revealed upon further examination.
2. change the sensitivity. The sciatic nerve has sensory fibers, therefore, when the lesion revealed impaired sensation. The phenomenon affects the lateral (side) surface of the lower limb, almost the entire cutaneous surface of the foot.
3. impaired mobility. Due to the presence of motor fibers in the nerve damage develop movement disorders.
4. Forced position taken by the patient, is associated with pain syndrome. The patient tries to be in the position in which the pain subside.
5. change the color of the skin innervated site. Due to the innervation and circulation, the skin takes on a pale hue.
6. Muscle atrophy due to violation of innervation and motor activity.

Violation reflexes

upon further examination a neurologist detected the following clinical manifestations:

1. Weakening of the knee reflex, which is usually revealed when sciatica due to herniated discs located between the vertebrae L1-L4.
2. Weakening of the Achilles reflex. When you hit located on the Achilles tendon shortens the calf muscle. In the case of sciatica reflex reduced or absent (in more severe cases).
3. weakening of the plantar reflex. It consists in flexing the foot and toes when carrying out with a small hammer on the sole. When the disease reaction reduced.

The Main symptoms are determine how to treat sciatica.

Diagnosis

Differential diagnosis allows to distinguish the diagnosis of "sciatica" from other diseases. Detection of pathology based on the definition of specific symptoms of sciatica during examination, collection of complaints and anamnesis.

X-ray

x-Ray study allowsto establish a diagnosis of "sciatica" that is caused by the change of shape and position of the vertebrae, and abnormalities of the intervertebral discs. This method is the most simple and accessible, however, you should remember about the contraindications. A relative contraindication is pregnancy and breastfeeding. To prevent the procedure is expressed by the restless condition of the patient, the picture will be blurry.

CT

Computed tomography is more informative. This method allows to determine other causes of diagnosis of "sciatica". The procedure is not done in pregnant women.

MRI

Magnetic resonance imaging allows to obtain more clear and informative image of the tissues. This method can be called the most effective, but the list of contraindications it is quite extensive. The procedure is contraindicated in patients with artificial pacemaker, metal implants in their body, with Ilizarov apparatus.

After a diagnosis of "sciatica", treatment should be immediate.

How to treat sciatica?

Good results are obtained with combination therapy that combines medication, physical therapy techniques, osteopathy, manual therapy, massage and medical gymnastics. The disease duration is four to eight weeks.

Medication

If the nerve is inflamed for the relief of pain can be prescribe analgesics (NSAIDs and other drugs), the type and method of administration of which depends on the intensity of pain.

Analgin

In uncomplicated cases, use Analgin, which is the most common drug. Additionally it gives anti-inflammatory effect. Pills are ineffective, the drug is usually administered in the form of injections. How much to prescribe, a physician determines in a particular case, it depends on the intensity of pain. The maximum daily dose is two grams.

More effective medications that contain additional active substance (combined). Examples are "Tempalgin", "Sedalgin", "Pentalgin", "Andipal".

Contraindications:

• allergic reaction
• pathology of the blood;
• could be.

Side effects:

• oppression
• Allergy.

Movalis

Patients with very severe pain you can apply "Movalis", which has anti-inflammatory and analgesic effect. Administered as injections, tablets is the maximum daily dose of 0,015-0,03 g

Contraindications:

• allergic reaction
• peptic ulcer disease;
• Crohn's disease
• liver and kidney failure in severe;
• pregnancy
• breastfeeding.

Side effects (rare):

• changes of the leukocytic formula;
• allergies
• diarrhea;
• nausea
• vomiting
• headache;
• drowsiness
• irritability
• increased blood pressure
• tachycardia
• swelling at the injection site.

Diclofenac

Also in severe pain, you can choose "Diclofenac" that relieves pain, inflammation and swelling. Is injected intramuscularly, issued in the form of tablets, gels, ointments.

Contraindications:

• allergic reaction
• pathology of the blood;
• bowel disease
• peptic ulcer
• pregnancy (last trimester).

Side effects (rare):

• nausea
• flatulence
• constipation or diarrhea
• vomiting
• gastropatia;
• hepatitis
• pancreatitis
• blood violations;
• allergies
• increased blood pressure
• convulsions.

These and other NSAIDs used in the treatment of sciatica, is presented in the figure below.

Local anaesthetics

In severe cases it is recommended to conduct lidocaine or novocaine blockade carried out at a certain point (Voyno-Yasenetsky). It promotes relief of severe pain syndrome, not amenable to traditional NSAIDs. To enhance the effect of possible combination of hydrocortisone with Novocain.

Contraindications:

• allergic reaction
• pregnancy.

Vitamins

It is also prescribed B vitamins that support nervous system function. According to studies, b vitamins (B1, B6) potentiate the effect of NSAIDs, while the period of pain is reduced significantly. The main drugs in this group:

1. "Milgamma";
2. Vitamin b 1 in the ampoule;
3. Vitamin b 6 in capsules;
4. "Neuromultivit" – appointed after the course of injections (usually 10 to 14) on 1-1,5 months.

In Addition to the listed groups of drugs, muscle relaxants Central action ("Mydocalm", "Baclofen", "Sirdalud"), as well as "Katadolon", "Tramadol" (for very severe pain, prescription drugs).

Massage

This procedure has a distracting effect, and also improves blood circulation. Pain causes muscle spasm, which is relieved with massage. In addition, an improvement of lymph drainage and easing edema. Massage action promotes the release of biologically active substances, they have aanti-inflammatory effect and reduce pain, helping to cure the disease.

physical Therapy

In this case, assign UHF, an electrophoresis, a magnetotherapy.

UHF

The Procedure is the impact on the currents. The method promotes the heating of tissue, which decreases pain and the degree of inflammation. UHF-therapy also improves circulation.

Contraindications:

• allergic rash in the region of passage of the sciatic nerve;
• infectious disease
• Oncology
• pustular formation.

Electrophoresis

This Method is used for administering pharmaceuticals through the skin. The improvement is due to the effect of a constant current. The procedure lasts 10-15 minutes normally it takes 10 visits.

Contraindications are the same as UHF therapy.

Magnetic therapy

Cure sciatica magnetic therapy helps. Treatment is provided by a magnetic field, which has high penetrating ability, has analgesic and anti-inflammatory effect. In addition, is anti-edematous action and normalizes blood circulation. As a rule, prescribed 10 sessions.

Contraindications:

• epilepsy
• pathology of blood coagulation;
• hypertension (third stage);
• exhaustion.

How long the disease depends on the effectiveness and timeliness of treatment.

physiotherapy

Exercises are prescribed only after subsides pain. However, even in this period do not overload the body, you can choose only light exercise. In the acute stage should stay in bed.

Prevention relapse

For prevention can be recommended regular exercise that help to strengthen the muscles and eliminate stiffness. Moderate physical activity not only improves muscle tone but also contribute to normal functioning of the nervous system. However, the overload, on the contrary, can provoke pain. Patients are advised not to lift weights. Effective swimming, walking and gymnastics. Also prevent the aggravation of the physical therapy programs. Good result give orthopedic pillows and corsets.

Sources:

1. Visual neuroscience. R. Barker and others. GEOTAR-Media, 2006;
2. back Pain. Vasenina E. E., Levin O. S., the Department of neurology of the Russian Academy of;
3. Neurology, a series of lectures. Matveev S. V., Department of neurology medical University named after. I. I. Mechnikov