Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Lumbosacral radicular syndrome ++ 355.0 Lesion of sciatic nerve722.73 Intervertebral disc disorder with myelopathy, lumbar region724.3 Sciatica724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified ++ G57.00 Lesion of sciatic nerve, unspecified lower limbM54.16 Radiculopathy, lumbar regionM54.17 Radiculopathy, lumbosacral regionM54.3 Sciatica ++ 4F: Impaired joint mobility, motor function, muscle performance, range of motion, and reflex integrity associated with spinal disorders34E: Impaired joint mobility, motor function, muscle performance, and rang of motion associated with localized inflammation3 +++ 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 examinationDermatome/myotome pattern compared to peripheral nerve distributionReproduction of symptoms +++ General Considerations ++ Presence of leg pain significantly increases the odds of condition becoming persistent +++ Demographics ++ NonspecificMost individuals will have sciatica symptoms at least once in their lifetime +++ Signs and Symptoms ++ Pain radiating down the leg(s), below the knee, along the distribution of the sciatic nerveUsually related to mechanical pressure and/or inflammation of lumbosacral nerve rootsCan be with or without lower back painDiminished sensation, motor control, and reflexes in the distribution of the involved nerve +++ Functional Implications ++ Difficulty maintaining sustained sitting postures secondary to back and leg painInability to sleepWeakness with lifting, prolonged standingLoss of movement or feeling in the LEDifficulty 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 hamstringsProlonged occupational stressesPregnancyDisc pathology, other sources of nerve root compressionSmoking +++ Differential Diagnosis ++ Peripheral nerve impairmentHip pathology with radiating pain patternSpinal tumorLyme diseasePeripheral neuropathyParaspinal muscle hypertonicityDegenerative disk diseaseSacral or pelvis dysfunction +++ Imaging ++ MRI helpful in diagnosis to visualize compressed or inflamed nerve rootX-ray/plain film radiograph helpful if osteophyte located in intervertebral foramenCT scan to show herniation compressing the spinal canal/nervesElectrodiagnostic/nerve conduction testing can assist to determine a specific impaired nerve function ++ Physical examinationAlgorithm for examination of the lumbar spineQuadrant testFABER testRotation limited to ipsilateral sideStraight leg raise testCrossed straight leg raise testSlump testLower limb nerve tension testPatella, Achilles, hamstring reflexLower limb sensation testingRadicular patternPassive physiological intervertebral mobility testing (PPIVM)Repeated lumbar movementsProne instability test ++ ImagingSurgical consult if myelopathy is suspectedFusionDecompressionLaminectomyLaser ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.