Sciatica Diagnosis

How To Diagnose Sciatica

Arriving at an accurate sciatica diagnosis requires uncovering the true cause of your sciatica symptoms.

Sciatica is not a diagnosis. It is a set or group of symptoms. The presence of one or more of these symptoms, along with a positive straight leg raise test, is termed sciatica. The actual cause of the sciatica, which will be the sciatica diagnosis, needs to be established.

In order for the symptoms to be called sciatica one or more of the following must be present:

Symptoms - These symptoms can be present with other conditions as well.

  • pain in the body areas innervated by the sciatic nerve
  • tingling or pins and needles sensation
  • numbness
  • reduced or loss of muscle strength

Signs - These tests may or may not be positive. If positive it is likely that the symptoms are sciatica.

  • positive straight leg raise test
  • positive dorsi-flexion of foot test

This straight leg raise (SLR) test is performed with the patient lying on her back. The examiner grasps the leg with one hand at the ankle and slowly lifts the entire straight leg off the table toward the ceiling.

Ideally the patient should not experience any pain, or increase in pain, for a normal or negative finding. If pain is noticed or increased between 30 to70 degrees the test is deemed positive.

This action, lifting the straight leg, will put a slight stretch or tension on the sciatic nerve. Either the increased tension of the nerve or increased pressure on the sciatic nerve by the offending disc bulge or stenosis will further cause stimulation or activation of the nerve fibers. This action will then increase the pain noticeably.

The dorsi-flexion of the foot test is initially carried out in the same manner as the straight leg raise test. The only difference is when the leg is lifted to the degree that elicits pain it is then backed off until the pain is relieved.

At this point the examiner grasps the bottom of the foot and bends it head-ward. This puts the sciatic nerve on stretch once again. If the pain is increased the test is considered positive for sciatica.

The examiner must make sure the pain experienced is a direct reproduction of the sciatica pain and not pain caused by muscle strain or perhaps pain arising in the calf from a strain, deep vein thrombosis or phlebitis.

If the symptoms and signs are present for sciatic nerve pain , then the cause must be uncovered. It is the cause that will be the diagnosis.

For example, symptoms of pain in the buttocks and along the outside lower leg, with tingling and numbness in the large toe and a positive straight leg raise test is termed sciatica.

When an MRI is performed, if there is the presence of disc bulging that is compressing the L5 nerve root, then this would be described as: L4-5 disc herniation resulting in L5 nerve root compression which in-turn is causing sciatic. Here the diagnosis or the condition causing the sciatica would be "L4-5 disc herniation".

All too often physicians focus too much of their attention on symptom relief and ignore treatment and correction of the cause.

Most cases of sciatica will resolve overtime.

If conservative treatment fails to offer significant relief, or the sciatic pain is severe and lasting more than six months, or some type of nerve paralysis in the form of muscle degeneration, foot drop, bladder incontinence is present, then surgery may be the best option.

If there is no evidence of permanent nerve damage a nonsurgical treatment is better in the long term.

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