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A condition in which pain emanating from the lower back is felt along the distribution of the sciatic nerve in the lower extremity.
SEE: meralgia; SEE: piriformis syndrome; SEE: sciatic nerve
In Western countries, about 40% to 50% of the population will experience sciatica at some time during their lives. Recovery follows conservative treatment in 3 to 4 weeks for most patients.
Sciatica may be caused by compression or trauma of the sciatic nerve or its roots, esp. that resulting from a ruptured intervertebral disk or osteoarthrosis of the lumbosacral vertebrae; inflammation of the sciatic nerve resulting from metabolic, toxic, or infectious disorders; or pain referred to the distribution of the sciatic nerve from other sources.
SYMPTOMS AND SIGNS
Sciatica may begin abruptly or gradually and is characterized by a sharp shooting pain running down the back of the thigh. Movement of the limb or lower back generally intensifies the suffering. Pain may be uniformly distributed along the limb, but frequently there are certain spots where it is more intense. Numbness and tingling may be present, and the skin innervated by the nerve may occasionally be hypersensitive to light touch.
Physical examination of the patient may reveal pain in the lower back during straight leg raising, muscle spasm adjacent to the lumbar spine, or changes in lower extremity motor function or reflexes.
Although sciatica may be extremely painful and temporarily disabling, in more than 80% of patients it gradually resolves with mild activity restrictions and nonsteroidal anti-inflammatories, narcotic analgesic drugs, or muscle relaxants. Patients whose symptoms do not improve with these therapies should be reevaluated professionally. Occasionally, surgery of the lower back, e.g., to remove a herniated disk, is needed although surgery is performed much less commonly than in the past because conservative medical therapy in most instances provides equivalent long-term results.
Patients with sciatica who have had a history of cancer, injecting drugs, or fevers associated with sciatica, or people who lose control of bowel or bladder function in association with low back pain should be evaluated immediately with radiological studies for diseases and conditions such as spinal cancer, spinal epidural abscess, or damage to the spinal cord. Older patients also may require earlier and closer follow-up care than younger patients. Patients for whom sciatic pain is disabling but in whom objective pathology is not easily demonstrated may benefit from multidisciplinary approaches to their symptoms, e.g., with referrals to chronic pain clinics, chiropractors, physical and occupational therapists, physiatrists, or other specialists.