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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

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 lower back pain

  • 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 secondary to pain such as driving or twisting

Possible Contributing Causes

  • 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

Differential Diagnosis

  • 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

Means of Confirmation or Diagnosis

Imaging

  • 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

Findings and Interpretation

  • Physical examination

    • Algorithm for examination of the lumbar spine

    • Quadrant test

    • FABER test

    • Rotation limited to ipsilateral side

    • Straight leg raise test

    • Crossed straight leg raise test

      ...

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