Sciatica Causes and Treatments
Domenico Cotugno (Fig. 5), an eighteenth century Italian physician (7), introduced the term sciatica into the medical vocabulary. Without having knowledge of the common etiology of this disabling spinal disorder, he described some of the signs and symptoms commonly seen in association with sciatic pain. Subsequently, Cotugno's disease as an entity gained acceptance in European medicine. Associated clinical findings of sciatica
The use of Lipiodol is indispensable, not only with radiography but also with fluo-roscopy. The prognosis depends upon surgical treatment which is midline through the dura. If the protrusion is very lateral, the dura mater should be incised laterally. There is a problem with retraction of the spinal cord in the neck and thorax, particularly evident when the nodule is calcified and embedded in the cord. Such nodules should be suspected in refractory lumbalgia and sciatica. A brickmaker, 44 years old, was hospitalized by Dr. Crouzon for refractory sciatica that had kept him out of all work for 6 months. There was no special precipitating factor, but there was a history of an acute injury to the lumbar region 7 years earlier when he fell 4 meters onto his back and kidneys. After severe pain immobilized him for some days, he was able to go back to work, but with intermittent episodes of lumbago making him rest for 3 to 4 days. Only after 7 years did he begin to have (In June 1930) pains...
Much the same manner as the free technique. The use of mesh has markedly reduced the incidence of abdominal hernia formation and bulging. Although these patients have objective loss of abdominal function, subjective interference with daily activity is rare. There are reports of an increased incidence of long-term lower back pain.
The major structure at risk with this approach is the sciatic nerve. It is imperative that this nerve not be damaged. The nerve is fairly far medial. If the approach to the hip joint is through the external rotators along their insertion into the greater trochanter, then the nerve will be protected by those muscles as they are retracted. The nerve is easy to identify because of the loose tissue around it and because it is large and runs longitudinally, whereas all the other structures in the area run transversely.
Sciatic nerve lateral trunk lesion Fig. 45. Tibial nerve anatomy. Tibial nerve originates from sciatic nerve above the knee at variable sites Fibers for the tibial nerve come from L3-S4. The nerve originates from the medial part of the sciatic nerve. It has a protected position in the thigh and popliteal fossa. In the lower leg, the tibial nerve innervates the gastrocnemius, posterior tibial, flexor digitorum longus, and flexor hallucis muscles. It passes through the tarsal tunnel (behind the medial malleolus), along with the tibial posterior artery and tendons of the posterior tibial and short flexor digitorum muscles. Here the nerve branches into the medial and lateral plantar nerves. The medial plantar nerve innervates the abductor hallucis and the short flexor digitorum brevis. The lateral plantar nerve innervates the flexor and abductor digiti minimi, the adductor hallucis and the interosseous muscles. The sensory fibers from both plantar nerves innervate the sole of the foot....
In the MPTP model of Parkinson's disease, mice transplanted with MSCs by intrastriatal injection at 1 wk after MPTP administration performed significantly better on the rotarod test compared with controls (88). Delayed injection of MSCs into the rat spinal cord 1 wk after contusion led to long-term improvement of locomotor function (68), and MSCs injected intravenously into rats after traumatic brain injury reduced motor and neurological deficits by d 15 (69). Moreover, regeneration of the axotomized sciatic nerve was accelerated by the local transplantation of MSCs predifferentiated into a Schwann cell-like phenotype (76). MSCs were also found to remyelinate the rat spinal cord after focal demyelination induced by irradiation ethidium bromide (75,89). Finally, survival of a knockout mouse model of Niemann-Pick disease was enhanced after intracerebral transplantation of MSCs genetically engineered to express acid sphingomyelinase (90). Thus, the use of bone marrow stem cells holds...
Like its counterpart, the inferior gluteal flap is indicated in rare patients who refuse prosthetic reconstruction and who are not candidates for either TRAM, lateral thigh, or latissimus flaps. Although the length of the donor inferior gluteal vessels enable anastomosis to the more forgiving thoracodorsal pedicle and the donor site scar is the least conspicuous of any autogenous option, harvest necessitates sacrifice of the gluteal motor nerve, occasional sacrifice of the posterior cutaneous nerve, and close dissection to the sciatic nerve, all of which may lead to transient pain syndromes and weakness with ambulation prolonged rehabilitation may be required. For these reasons, the gluteal flap is generally the least favored flap in the breast reconstruction algorithm.
Minimum and, secondly, how to prevent death from blood loss. Before general anaesthesia, pain-relieving measures were generally ineffective because of profound uncertainties in administering safe doses of soporifics and opiates, although alcohol sometimes bolstered morale. Other measures included the application of tight bandages, later termed tourniquets, to numb tissues below the bandaging and also specific attempts to paralyse individual nerves to the limbs by applying compressors, as suggested by Moore in 1784.4 Moore's scheme required placing the compressor head accurately on the sciatic nerve or femoral nerve, or both together (see Fig. 8.3), without obstructing adjacent veins or arteries, and maintaining compression for up to an hour before sensory loss below was effective. In practice, this proved extremely difficult if not dangerous and also a painful experience for the patient, leading to abandonment of the method. Sadly, only hypnosis offered a possibility of relief before...
21 Sciatic nerve Femoral nerve injury results in decreased hip flexion and leg extension due to the loss of the iliacus, rectus femoris, vastus lateralis, intermedius and medialis, and sartorius muscle function. Injury to the obturator nerve results in loss of leg adduction and pronation from loss of the adductor brevis, longus and magnus, as well as obturator externus and gracilis muscle innervation. The sciatic nerve is not usually injured during surgical procedures but can be compromised by cervical cancer spread to the lateral pelvic wall, causing significant pain. Pain, secondary to cancer or postoperative, can be controlled in the pelvis by regional anesthetic blockade of the dorsal nerve roots of T10, T11, and T12 to the uterus tubes and ovary, and S2, S3 and S4 to the remaining genital structures (see Chapter 22).
Muscle contraction has often been studied and demonstrated using the gastrocnemius (calf) muscle of a frog, which can easily be isolated from the leg along with its connected sciatic nerve (see insight 11.3). This nerve-muscle preparation can be attached to stimulating electrodes and to a recording device that produces a myogram, a chart of the timing and strength of the muscle's contraction.
Typical S3 responses include the following contraction of the levator ani muscles, causing a ''bellows'' contraction of the perineum (deepening and flattening of the buttock groove) plantar flexion of the big toe (and sometimes other toes) due to sciatic nerve stimulation and paresthesia in the rectum, perineum, scrotum or vagina.
Sciatic Nerve and Posterior Cutaneous Nerve of Thigh Tibial division of sciatic nerve Tibial division of sciatic nerve Sciatic nerve (L4, 5, S1, 2, 3) Common fibular (peroneal) division of sciatic nerve From sciatic nerve Sciatic nerve (L4, 5, S1, 2, 3) Common fibular (peroneal) division of sciatic nerve From sciatic nerve
The medial trunk of the sciatic nerve forms the tibial nerve, and is derived from the ventral branches of the same ventral rami (L4-S2). The sacral plexus pain resembles sciatic nerve injury. Depending on the lesion of the sacral plexus, motor symptoms are concentrated in L5, S1, resulting in weakness of the sciatic nerve muscles. Proximal muscles that exhibit weakness include the gluteus maximus muscle, but the gluteus medius muscle is usually spared. Sensory symptoms may also involve proximal areas, such as the distributions for the pudendal nerve and the posterior cutaneous nerve of the thigh. Sphincter involvement can occur.
Deficient neurotrophic support in injury or neuronal disease such as diabetic neur-opathy.227 Moreover' the neuropeptide changes in somatic sensory neurons and sciatic nerves of diabetic rats can be normalized by strict glycemic control' treatment with an aldose reductase inhibitor' or with exogenous NGF.204207227228 Deficient neurotrophic support may also be a factor in the defective neuronal repair and regeneration known to occur in diabetic neuropathy in humans and in animal mod-els.17146227 The established role for neurotrophins in nerve regeneration' and the finding that NGF assists sensory nerve regeneration in STZ diabetic rats244 support this idea. Thus' even in the presence of other causative mechanisms (e.g.' immuno-logical' increased aldose reductase pathway activity' microvascular abnormalities) for the diabetic neuropathy' correction of an alteration in function or availability of the appropriate neurotrophic factors may enhance maintenance of normal transmitter...
Fig. 33 (A) Axial FSE T2-weighted pelvic MR image revealing a mass invading the left sciatic nerve at the greater sciatic foramen (arrow). (B) Coronal FSE T2-weighted pelvic MR image revealing a mass invading the left sciatic nerve (arrow) at the greater sciatic foramen in a different patient. Fig. 33 (A) Axial FSE T2-weighted pelvic MR image revealing a mass invading the left sciatic nerve at the greater sciatic foramen (arrow). (B) Coronal FSE T2-weighted pelvic MR image revealing a mass invading the left sciatic nerve (arrow) at the greater sciatic foramen in a different patient.
In the writings of Hippocrates (460-370 bc) one can find references to the anatomy of the brain, brachial plexus, and sciatic nerve. In animal dissections it appears that he had difficulty in differentiating tendons from peripheral nerves. However, he attributed the development of paresthesia, weakness of the limbs, and fecal and urinary retention to spinal cord compression (1). to 1400 ad demonstrates the depth of curiosity of the times, and the information that was gathered from cadaver dissections. Their illustrations show the presence of 6 cervical, 12 thoracic, and 5 lumbar segments. The origins of the brachial plexus from the cervical segments, the intercostal nerves from the thoracic nerves, and the sciatic nerve from the lumbar segments are described. In addition, the two divisions of the sciatic nerve as it extends into the lower extremities are shown.
Sciatic nerve lesion Sciatic nerve Fig. 42. Sciatic nerve anatomy. Greater sciatic nerve. 1 Great sciatic nerve. 2 Gluteal superior nerve. 3 Infrapiriform foramen. 4 Peroneal nerve. 5Tibial nerve. 6 Semitendinosus muscle. 7 Semimembranosus muscle Fig. 43. Neurofibromatosis. Bilateral enlargement of the sciatic nerve in transverse a and longitudinal section b It is positioned on the dorsal side of the femoral bone, between the flexor muscles of the knee. The location of the division into the tibial and peroneal nerves varies, but usually occurs in the upper thigh. Fibers from the lateral and medial divisions of the sciatic nerve become the peroneal and tibial nerves. Fibers from the lateral division (peroneal nerve) are more prone to compression. The peroneal and tibial nerves include motor, sensory and autonomic fibers. Painful neuropathic syndromes can result from sciatic nerve lesions. Inspection and palpation along the sciatic nerve (the sciatic notch in the thigh). Signs...
Obturator nerve Gluteus medius Sciatic nerve Peroneal lesion may be part of sciatic nerve lesion Gabet JY (1989) Amyloid pseudotumor of the sciatic nerve. Rev Neurol 145 872-876 Roncaroli F, Poppi M, Riccioni L, et al (1997) Primary non Hodgkin's lymphoma of the sciatic nerve folowed by localization in the central nervous system. Neurosurgery 40 618621
The relative weight given to each criterion varies among communities and decision-makers and often must be negotiated among the involved parties. Some practitioners believe that the relationship between the rarity (prevalence) of a candidate disease and the proportion of false positives (persons without the target condition who test positive, given fixed sensitivity and specificity) is the most important principle of screening. This principle explains why selective screening strategies and risk-based strategies are often preferable to mass screening. Moreover, sequential screening to reduce false positives in the case of a rare disease increases in importance when the adverse consequences of a false positive test are severe and costly. In the final analysis, therefore, conditions of low morbidity and mortality (e.g., lower back pain) tend to be unsuitable candidates for screening even when highly prevalent. Similarly, conditions of high morbidity and mortality (e.g., HIV ) tend to be...
Proximal nerve stimulation studies are more difficult than the standard NCV Proximal nerve studies. Proximal stimulation can be performed near-nerve with electrical or stimulation studies magnetic stimulation. The proximal parts of nerves like the long thoracic, phrenic, spinal acessory, suprascapular, axillary, musculocutaneous, femoral and sciatic nerves can be evaluated by this method.
Dawson DM, Hallet M, Wilbourn AJ (1999) Sciatic nerve entrapment. In Dawson DM, References Hallet M, Wilbourn AJ (eds) Entrapment neuropathies. Lippincott Raven, Philadelphia, pp 264-269 Kornetzky l, Linden D, Berlit P (2001) Bilateral sciatic nerve Saturday night palsy . J Neurol 248 425 Schmalzried TP, Amstutz HC, Dorey FJ (1991) Nerve palsy associated with total hip replacement risk factors and prognosis. J Bone Joint Surg 73 1074-1080 Sunderland S (1953) The relative susceptibility to injury of the medial and lateral popliteal divisions of the sciatic nerve. Br J Surg 41 2-4 Fig. 44. Peroneal nerve anatomy. 1 Superficial peroneal nerve. 2 Deep peroneal nerve. 3 Sciatic nerve The peroneal nerve is the lateral trunk of the sciatic nerve, separating from the Anatomy sciatic nerve frequently in the upper popliteal fossa. The nerve originates from the posterior divisions of the ventral rami of L4, L5, S1, and S2.
This approach has a slightly higher dislocation rate following prosthetic implant in the hip joint than does an anterior approach. There is also some risk of damage to the sciatic nerve, which is not the case with the anterior approach. Also, in children, there is risk to the blood supply to the femoral epiphysis, which largely comes through the capsule. The most critical blood vessels come in at the pos-terosuperior corner of the capsule. For this reason, the posterior approaches to the hip are generally avoided in children with an open growth plate at the hip.
Figure 12.25 An Example of Neural Coding. This figure is based on recordings made from a sensory fiber of the frog sciatic nerve as the gastrocnemius muscle was stretched by suspending weights from it. As the stimulus strength (weight) and stretch increase, the firing frequency of the neuron increases. Firing frequency is a coded message that informs the CNS of stimulus intensity. In what other way is the CNS informed of stimulus intensity
The sacral plexus has nerves that provide genital innervation and also has motor nerves to the posterior hip, thigh, and anterior and posterior leg. The pudendal nerve innervates the penis and scrotum in males, the clitoris, labia, and distal vagina in females, and the muscles of the pelvic floor in both sexes. The sacral plexus also has the superior and inferior gluteal nerves that innervate the gluteal muscles and the tibial nerve and the common fibular nerve. These last two nerves are grouped together as the sciatic nerve, a large nerve of the posterior thigh. The tibial nerve innervates the hamstring muscles, the muscles of the calf, and the muscles originating on the foot. The common fibular nerve innervates the short head of the biceps femoris muscle, the muscles on the lateral side of the leg and the anterior surface of the leg. Cutaneous branches innervate the skin and muscular branches take motor information to the muscles. Label these nerves and color them in. e. S3, f. S4,...
Gangrene of the left buttock following umbilical artery catherization. The umbilical artery catheter was positioned in the iliac artery radiographical-ly. There is a well-known association between injection of medications into the umbilical artery and necrosis and gangrene of the buttock and sciatic nerve palsy. Figure 7.46. The same infant with unilateral gangrene of the buttock also had a sciatic nerve palsy as a result of the umbilical catheter being positioned in the iliac artery. Note the foot drop. Figure 7.46. The same infant with unilateral gangrene of the buttock also had a sciatic nerve palsy as a result of the umbilical catheter being positioned in the iliac artery. Note the foot drop.
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