It's a rare adult who hasn't suffered from sciatica at one time or another. Yet when these people seek care, most clinicians immediately think of disk disease or entrapment of the nerve root in the lateral recess(spinal stenosis). Many physicians unfortunately tend to overlook some of the common nondiskogenic causes of low back pain with radiation to the leg, there by subjecting thereby patients to unnecessary invasive diagnostic and therapeutic procedures.
Sciatica may well be a symptom of disk disease or root entrapment, but it may also portend a host of other common disorders. Many physicians consider low back pain and sciatica to be vague syndromes. As a result, a patient with sciatica may receive only generic treatment: bedrest, muscle relaxants, analgesics, and physical therapy. If these do not work, the patient often seeks a second opinion, and the diagnostic workup continues. Sooner or later -- and as costs mount -- the insurance company requests a second opinion, and then a third. Often, the patient undergoes a myelogram, CT scan, or laminectomy -- procedures that exact considerable expense and/or misery and that frequently prove unnecessary.1
The truth is that most causes of sciatica lend themselves to specific and less costly therapy. Physicians who look for the non-diskogenic causes of sciatica can often clinch the diagnosis--and relieve the patient's pain-- on the spot. However, the estimated 8 million Americans who are victims of low back pain and sciatica currently incur $5-6 billion dollars annually in diagnostic and therapeutic costs, not to mention $14 million billion per year in days lost from work, worker's compensation, disability payments, and litigation. 2
Dr. Namey's article helps physicians diagnose and treat the nine entities most commonly confused with disk disease or nerve root entrapment in a cost- effective manner. He emphasizes the clinical features of these disorders and helps distinguish among them with a minumum of expensive and evasive tests. For each entity reviwed, Dr.Namey addresses the question of how to provide specific therapy in an outpatient setting and return the patient to optimum function.
-Editor's noteTables Figures References Editors Post-Test Questions
The Non Diskogenic Causes of Sciatica
To provide specific therapy for patients presenting with sciatica, physicians must consider a host of other syndromes that frequently mimic lumbar disk disease and go unrecognized. These conditions -- sacroiliitis, piriformis syndrome,......
Sacroiliitis: Poosibile Harbinger of the Seronegative Spondyloarthropathies
At least 2-3% of the population suffers from sacroiliitis, a frequent initial manifestation of one of the seronegative Spondyloarthropathies. Most patients however, do not develop manifestations of overt spine disease......
Identifying Piriformis Syndrome
Distinguishing piriformis syndrome--spasm, irritation, or inflammation of the piriformis muscle-- from a herniated nucleus pulposus often proves confusing, since sciatica is common to both entities.......
Iliolumbar Syndrome: A Commonly Unrecognized Cause of Sciatica
Iliolumbar syndrome-- also known as lumbosacral sprain--is a frequently unrecognized cause of sciatica that results from inflammation, sprain, or tear of the iliolumbar ligament. This ligament bridges the transverse process of the fifth ......
Diagnosis of quadratus lumborum -- a condition related to, but less common than, iliolumbar syndrome-- is relatively easy for physicians who are aware that syndrome exists. The quadratus lumborum muscle arises from iliolumbar ligament and......
Trochanteric bursitis is a form of pelvic girdle pain commonly misdiagnosed as a lombosacral problem or arthritis of the hip. This entity is a frequent cause of sciatica in elderly patients.......
Ischioglutial Bursitis: The Classical Pain in The Arse
Suspect ischiogluteal bursitis in patients with the pain localized primarily to the buttock. Non-orthopedic physicians often misdiagnose this entity and, in particular, mistake it for a herniated lumbar disk.......
Posterior Facet Syndrome: A common Misdiagnosis
Posterior facet syndrome-instability of the back-is a much-abused and maligned diagnosis. Yet some patients suffer back pain caused by chronic synoival inflammation and degenerative disease and instability in the facet joints, most frequently those of......
Meralgia parasthetica-an entrapment neuralgia of a lateral femoral cutaneous nerve-is called by a variety of disorders and can occasionally be confused with sciatica.......
Helping the Patient Avoid Further Disability
In addition to specific therapy, all patients with sciatica benefit from some general measures. Encouraging aerobic activity is important, and swimming, dancing, and walking are all excellent forms of exercise. Also encourage patients to strengthen their abdominal muscles by performing modified sit-ups and by keeping these muscles taut while standing.......
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