Orthopedics Book



Aka: Sciatica, Sciatic Pain, Deep Gluteal Syndrome, Gluteal Tendinopathy
  1. See Also
    1. Low Back Pain
    2. Lumbar Spine Anatomy
    3. Low Back Pain History
    4. Low Back Pain Red Flags
    5. Sciatica
    6. Low Back Exam
    7. Differential Diagnosis of Low Back Pain
    8. Lumbar Disc Disease
    9. Low Back Imaging
    10. Low Back Pain Management
    11. Rheumatologic Conditions affecting the Low Back
    12. Low Back Pain in Children
    13. Low Back Pain in Teen Athletes
  2. Definitions
    1. Deep Gluteal Syndrome
      1. Sciatic nerve or pudendal nerve entrapment causing deep buttock pain with Sciatica worse with sitting
      2. Causes include Piriformis Syndrome
      3. Entrapment may also occur with proximal hamstring or Gemelli–Obturator Internus entrapment
  3. Pathophysiology
    1. Peripheral Neuropathy due to sciatic nerve impingement
      1. Proximal or radicular impingement (e.g. Lumbar Disc Herniation)
      2. Distal impingement (e.g. Piriformis Syndrome)
  4. Symptoms
    1. Region: Low Back Pain
    2. Radiation: posterior buttock or postero-lateral thigh
  5. Diagnosis: Sciatica as a predictor for Lumbar Disc Disease
    1. Overall
      1. Only 4% of Sciatica is Lumbar Disc Disease
      2. Patients with symptomatic Lumbar Disc Herniation have Sciatica in 99% of cases
    2. Findings that increase Specificity of Sciatica for Lumbar Disc Disease
      1. Pain worse in the leg than the back
      2. Pain or numbness follows a typical dermatomal pattern
      3. Pain worse with Valsalva Maneuver (e.g. coughing or sneezing)
    3. Findings suggesting diagnosis other than Lumbar Disc Herniation
      1. See Low Back Pain Red Flags
  6. Differential Diagnosis: Sciatica
    1. Spinal conditions
      1. Lumbar Disc Herniation (most common cause)
      2. Lumbar spine Degenerative Joint Disease (osteophytes, bone spurs)
      3. Sponylolisthesis
      4. Facet Arthropathy
      5. Spinal Tumors
      6. Lumbar Spinal Stenosis (Pseudoclaudication)
      7. Vertebral Fracture
      8. Disciitis
    2. Musculoskeletal conditions external to the spine
      1. Greater Trochanteric Bursitis
      2. Iliotibial Band Syndrome
      3. Meralgia Paresthetica
      4. Piriformis Syndrome or other Deep Gluteal Syndrome
      5. Ischiofemoral Impingement
      6. Radiation from Hip Pain (may mimic L4 Lumbar Radiculopathy)
      7. Sacroiliac Joint Dysfunction or Spondyloarthropathy with Sacroiliitis

Sciatica (C0036396)

Definition (CHV) lower back pain radiating to the buttocks
Definition (CHV) lower back pain radiating to the buttocks
Definition (CHV) lower back pain radiating to the buttocks
Definition (MEDLINEPLUS)

Sciatica is a symptom of a problem with the sciatic nerve, the largest nerve in the body. It controls muscles in the back of your knee and lower leg and provides feeling to the back of your thigh, part of your lower leg, and the sole of your foot. When you have sciatica, you have pain, weakness, numbness, or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. It's usually on only one side of your body.

Causes of sciatica include

In many cases no cause can be found.

Sometimes sciatica goes away on its own. Treatment, if needed, depends on the cause of the problem. It may include exercises, medicines, and surgery.

Definition (CSP) syndrome characterized by pain radiating from the back into the buttock and into the lower extremity along its posterior or lateral aspect, and most commonly caused by protrusion of a low lumbar intervertebral disk; also used to refer to pain anywhere along the course of the sciatic nerve.
Definition (MSH) A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of SCIATIC NEUROPATHY; RADICULOPATHY (involving the SPINAL NERVE ROOTS; L4, L5, S1, or S2, often associated with INTERVERTEBRAL DISK DISPLACEMENT); or lesions of the CAUDA EQUINA.
Concepts Sign or Symptom (T184)
MSH D012585
ICD9 724.3
ICD10 M54.3, M54.30
SnomedCT 202795003, 156649007, 23056005
Dutch ischias (ziekte van Cotugno), ischiatische neuralgie, ischialgie, ischias, Ischialgie, Ischias, Neuralgie van de nervus ischiadicus
French Ischions, Ischialgie, Sciatique, Névralgie du nerf sciatique, Sciatalgie, Névralgie sciatique
German Ischias, Cotugno-Syndrom, Ischialgie, Ischiasneuralgie, Neuralgie, Ischias-
Italian Ischiatico, Malattia di Cotugno, Ischialgia, Nevralgia sciatica, Sciatalgia, Sciatica
Portuguese Doença de Cottugno, Nevralgia ciática, Ciatalgia, Neuralgia Isquiática, Isquiática, Ciática, Neuralgia Ciática
Spanish Enfermedad de Cotugno, Neuralgia ciática, Isquialgia, ciática (trastorno), ciática, neuralgia - neuritis del nervio ciático mayor, neuralgia ciática, Ciática, Neuralgia Ciática
Japanese コトゥーニョ病, コトゥーニョビョウ, ザコツシンケイツウ, 坐骨神経痛
Swedish Ischias
Czech ischialgie, Neuralgie nervus ischiadicus, Ischialgie, Cotugnova nemoc, Ischias
English Ischialgia, sciatica (diagnosis), sciatica, Ischias, Neuralgia, Sciatic, Sciatic Neuralgia, Neuralgias, Sciatic, Sciatic Neuralgias, Sciatica, unspecified side, Sciatica [Disease/Finding], sciatic neuralgia, ischia, ischias, Sciatia, Cotugno's disease, Sciatic neuralgia, Neuralgia-neuritis of sciatic nerve, Sciatica neuralgia, Sciatica (disorder), ischialgia, Sciatica, Neuralgia or neuritis of sciatic nerve
Finnish Iskias
Korean 좌골신경통
Polish Rwa kulszowa, Nerwoból nerwu kulszowego
Hungarian Cotugno-féle betegség, Ischias, Ischiadikus neuralgia, Ischiás, Ischialgia
Norwegian Isjias, Ischias
Derived from the NIH UMLS (Unified Medical Language System)

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