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139: SCIATICA

Arie J. Van Duijn, EdD, MSc, PT, OCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYM

  • Lumbosacral radicular syndrome

ICD-9-CM CODES1

  • 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

ICD-10-CM CODES2

  • G57.00 Lesion of sciatic nerve, unspecified lower limb

  • M54.16 Radiculopathy, lumbar region

  • M54.17 Radiculopathy, lumbosacral region

  • M54.3 Sciatica

PREFERRED PRACTICE PATTERNS

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders3

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation3

PATIENT PRESENTATION

A 32-year-old female presents with complaints of left ischial pain with sciatic radiation of the pain. She reports that the pain has been present for approximately 5 months. Since the onset of symptoms, the ischial pain has not decreased in intensity. The sciatic pain radiation has also not improved, however, has not progressed or moved further distally. She recalls a fall approximately 2 months prior to the onset of symptoms when she fell on her left buttock along the edge of a carted stairway. She was carrying a heavy object at the time, and reports a significant black and blue on her left buttock that lasted for about 3 weeks.

Since the onset of symptoms she had extensive medical workup, including an MRI and CT scan that were both negative for lumbar radiculopathy. The primary complaints of pain are with sitting or standing, there is relief of symptoms when lying. There is significant point tenderness over the piriformis muscle. Stretching of this muscle reproduces the complaints.

KEY FEATURES

Description

  • Low back pain radiating into the lower extremity (LE)

  • Can result from lateral lumbar/sacral spine nerve root compression or piriformis syndrome

Essentials of Diagnosis

  • Diagnosis made by clinical examination

  • Dermatome/myotome pattern compared to peripheral nerve distribution

  • Reproduction of symptoms

General Considerations

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

Demographics

  • Nonspecific

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

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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 low back pain (LBP)

  • Diminished sensation, motor control, and reflexes in the distribution of the involved nerve

Functional Implications

  • 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 ...

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