Sciatic nerve pain down right leg

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

One of the most common problems seen by rheumatologists in the office is low back pain. And one of the most common complications of low back syndromes is sciatica.

Sciatica usually goes down one leg- right or left- without significant preference to one side or another.

Sciatica refers to pain that radiates along the sciatic nerve and is typically felt in the rear, down the back of the leg and possibly to the foot. Sciatica is one of the most common forms of pain caused by compression of the spinal nerves, and the leg pain often feels much worse than the back pain.

The sciatic nerve is the largest and longest single nerve in the human body. The nerve originates in the lower spine as nerve roots exit the spinal cord and extends all the way down the back of the leg to the toes.

The sciatic nerve is a combination of nerves. It is formed on the right and left hand side of the lower spine by the combination of the fourth and fifth lumbar nerves and the first three nerves in the sacral spine. Each nerve exits the spine between two vertebral segments and is named for the segment above it.

• The nerve that exits between lumbar segment 4 and lumbar segment 5 (L4 and L5) is called the L4 nerve root, and the nerve that exits between the L5 and sacral segment 1 is called the L5.
• The nerves that emerge from the sacral foramen are called the S1, S2 and S3 nerves.

The five nerves group together on the front surface of the piriformis muscle (in the buttock) and become one large nerve. This nerve travels then down the back of each leg, branching out to innervate specific regions of the leg and foot.

In the lower thigh/above the back of the knee, the sciatic nerve divides into two nerves, the tibial and peroneal nerves, which innervate different parts of the lower leg:

• The peroneal nerve travels laterally along the outer aspect of the knee to the upper foot.
• The tibial nerve continues to travel downward towards the feet and innervates the heel and sole of the foot.

The sciatic nerve supplies sensation and strength to the leg as well as the reflexes of the leg. It is the main electrical connection from the spinal cord to the entire leg. When the sciatic nerve is impaired it can lead to symptoms such as muscle weakness in the leg and/or, numbness or tingling.

Sciatica is usually caused by pressure on the sciatic nerve from a herniated disc (also called a ruptured disc, pinched nerve, slipped disk, etc.). The problem is often called a "radiculopathy", meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the nerve root, which connects with the sciatic nerve.

Sciatica is actually a symptom and not a diagnosis.

Most often, sciatica pain is caused when the L5 or S1 nerve root in the lower spine is irritated by a herniated disc. When this happens, pain radiates into the rear and back of the thigh and calf, and occasionally may extend down to the foot. Numbness, tingling, and/or a burning or prickling sensation are also common symptoms.

Degenerative disc disease may also irritate the nerve root and cause sciatica, while conditions that mimic sciatica include piriformis syndrome and sacroiliac joint dysfunction. Sciatica may also be felt if the nerve is mechanically compressed from other reasons such as spondylolisthesis, spinal stenosis, or arthritis in the spine.

For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse. pain often radiates from the lower back all the way down the back of the thigh and down the leg. Depending on where the sciatic nerve is affected, the pain may also radiate to the foot or toes. The radiation pattern may help the clinician to identify which nerve root is being pinched.

One or more of the following sensations may occur as a result of sciatica:

• Pain in the buttock or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness or difficulty moving the leg or foot
• A constant pain on one side of the buttock
• A shooting pain that makes it difficult to stand

Most sciatic pain syndromes result from inflammation and will resolve within two weeks to a few months.

Symptoms that may constitute a medical emergency include progressive weakness in the legs or bladder/bowel incontinence. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention.

Clinical diagnosis starts with a careful history and physical examination.

A CT scan or an MRI scan are helpful in diagnosis. EMGs are electrical tests that can detect radiculopathy.

Nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these factors. Typical sciatica treatments include:

• Manual treatments (including physical therapy and osteopathic or chiropractic treatments) to help relieve the pressure. Treatments may include ultrasound, electrical stimulation, exercises, and traction.
• Medical treatments for sciatica (such as NSAID’s, oral steroids, or epidural steroid injections) to help relieve the inflammation.
• Surgery for sciatica (such as microdiscectomy or lumbar laminectomy) may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments or there is a progressive neurologic deficit.

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