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  • Lumbosacral radicular syndrome

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  • 355.0 Lesion of sciatic nerve
  • 722.73 Intervertebral disc disorder with myelopathy, lumbar region
  • 724.3 Sciatica
  • 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified

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  • G57.00 Lesion of sciatic nerve, unspecified lower limb
  • M54.16 Radiculopathy, lumbar region
  • M54.17 Radiculopathy, lumbosacral region
  • M54.3 Sciatica

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Description

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  • Low back pain radiating into the lower extremity (LE)
  • Can result from lateral lumbar/sacral spine nerve root compression or piriformis syndrome

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Essentials of Diagnosis

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  • Diagnosis made by clinical examination
  • Dermatome/myotome pattern compared to peripheral nerve distribution
  • Reproduction of symptoms

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General Considerations

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  • Presence of leg pain significantly increases the odds of condition becoming persistent

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Demographics

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  • Nonspecific
  • Most individuals will have sciatica symptoms at least once in their lifetime

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Signs and Symptoms

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  • Pain radiating down the leg(s), below the knee, along the distribution of the sciatic nerve
  • Usually related to mechanical pressure and/or inflammation of lumbosacral nerve roots
  • Can be with or without lower back pain
  • Diminished sensation, motor control, and reflexes in the distribution of the involved nerve

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Functional Implications

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  • Difficulty maintaining sustained sitting postures secondary to back and leg pain
  • Inability to sleep
  • Weakness with lifting, prolonged standing
  • Loss of movement or feeling in the LE
  • Difficulty with movements secondary to pain such as driving or twisting

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Possible Contributing Causes

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  • Postural changes including weakness of core musculature and tightness of hip flexors, external rotators, and hamstrings
  • Prolonged occupational stresses
  • Pregnancy
  • Disc pathology, other sources of nerve root compression
  • Smoking

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Differential Diagnosis

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  • Peripheral nerve impairment
  • Hip pathology with radiating pain pattern
  • Spinal tumor
  • Lyme disease
  • Peripheral neuropathy
  • Paraspinal muscle hypertonicity
  • Degenerative disk disease
  • Sacral or pelvis dysfunction

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Imaging

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  • MRI helpful in diagnosis to visualize compressed or inflamed nerve root
  • X-ray/plain film radiograph helpful if osteophyte located in intervertebral foramen
  • CT scan to show herniation compressing the spinal canal/nerves
  • Electrodiagnostic/nerve conduction testing can assist to determine a specific impaired nerve function

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