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Sciatica (lumbar radiculopathy) - Management
What else might it be?
- Pain referred to the upper leg may be more common than sciatica. Pain can be referred to the upper leg from the hip, sacroiliac, and intervertebral facet joints, by a trigger point (an area of soft tissue that is very painful when compressed), and by painful muscles or tendons.
- Conditions that can be confused with sciatica include:
- Sacroiliitis in ankylosing spondylitis and other spondyloarthropathies — with arthropathies, the pain often alternates between buttocks.
- Pyriformis syndrome — the sciatic nerve is compressed or irritated where it is covered by the piriformis muscle. Clinical diagnosis of pyriformis syndrome is difficult, but the syndrome can be excluded if imaging shows compression of the sciatic nerve root by a herniated intervertebral disc.
- Spinal claudication — bilateral calf pain, parasthesia, or numbness on walking.
- Nerve entrapment at the fibular head (peroneal palsy).
- Rarely, thalamic cerebrovascular accident, multiple sclerosis, thoracic spinal fracture, and 'phantom limb' phenomena cause pain similar to that of sciatica. However, these conditions do not have the other neurological symptoms and signs of nerve compression, such as numbness and tingling (paraesthesia), weakness, and loss of tendon reflexes, and (more importantly) they have other more widespread neurological features.
- Cauda equina syndrome — the cauda equina is the bundle of spinal nerves that lead out from the end of the spinal cord. Cauda equina syndrome occurs when these nerves are compressed and damaged. Symptoms include: leg weakness; loss of bowel, bladder, or sexual functions; and changes in sensation around the rectum and genitalia (saddle anaesthesia).
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