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Lumbar radiculopathy - Sciatica - Coggle Diagram
Lumbar radiculopathy - Sciatica
Tests
SLR (Sens High%, Spec Lower%) = Reproduce pain?
Slump Test (Sens 44-87%, Spec 23-63%) = More provocative.
Clear knee and hip.
Subjective
Pain, numbness, tingling, weakness in post aspect of LL including: bum, leg and foot. Follow dermatomal pattern.
Aggs: coughing/sneezing, bending forwards, twisting, catching it by certain movements
Insidious or MOI.
Radiating, shooting or traveling symptoms.
Pain descriptors = searing, sharp.
High VAS
Bilateral think spinal cord, unilateral think nerve root.
Objective
Observation: compensations in gait, avoiding one side.
Neuro testing
Myotomes = impaired
Demotes = Impaired
Reflexes = impaired.
LL muscle weakness may be present.
Reduced AROM due to pain.
Pathology
Directly related to the sciatic nerve. Often confused for other conditions.
Pain or nerve like symptoms located along path of sciatic nerve.
Common for herniated or bulging lumbar intervertebral disc to be cause. Other cause includes disc degeneration.
Radiculopathy is a loss of function (reflexes, strength, sensation).
Radicular pain results in a gain of function. Hypersensitivity, typical neuro symptoms.
Differentials
Referred pain.
Glute med/ proximal hamstring tendinopathy.
Trochanteric Bursitis.
Herniated disc.
Lumbar spinal stenosis.
Lumbar Spondylosis.
Treatment
Often can improve on its own with supported self management.
Rest advice around general fitness.
Stay active as pain allows.
Research
CSP - Encouragement to continue with normal activities as far as possible and promoting and self management and facilitating normal activities of daily living.
NICE - education and supported self management. Mobilisations and soft tissue only with exercise package.
Why this and not differential?
Nerve involvement due to neuro testing.
Catching it during certain movements.
Unilateral spreading of symptoms.
Description of pain during subjective.