Sciatic nerve neuropathy is a lesion of the longest nerve in the human body, passing from the sacral spine along the back of the thigh to the toes of the foot.
The outdated name for the disease, sciatica, is familiar to many. For ease of understanding between the doctor and the patient, it is still used today. The disease in the absence of treatment threatens with disability, in some cases leads to disability.
Causes
Sciatic nerve neuropathy (ICD-10 code G57.0) is one-sided. The most frequent cases of the disease are among people aged 40 to 60 years. Pathology refers to socially significant diseases, since it significantly affects the preservation of working capacity. For diagnosis and treatment, they turn to practicing vertebrologists, neurologists.
The most common causes of sciatic nerve neuropathy are:
- Neoplasms compressing the roots of a nerve.
- Infections (herpes, tuberculosis, scarlet fever, measles, HIV, etc.).
- Diseases of the pelvic organs.
- Prolonged hypothermia.
- Fractures or dislocations of the hip, spine.
- Metabolic disorders (diabetes, gout, etc.).
- Deep thigh wounds (lacerations, cuts, gunshots), hematomas.
- Pathology of the spine (hyperlordosis, scoliosis, spondylarthrosis, intervertebral hernia, etc.).
- Intoxications (alcohol, drug poisoning, the effects of chemicals).
Symptoms
Sciatic nerve neuropathy (sciatica) has many manifestations, the main symptom is severe pain. It can be localized in one place or spread along the entire length of the nerve, reaching the heel and fingers. Patients, characterizing pain, use such comparisons as dagger, burning. Almost always, the pain syndrome is very strong, sometimes the degree of pain is such that a person loses the ability to move independently.
The main symptoms of the disease:
- Palpation causes an exacerbation of pain in the posterior thigh, gluteus, and lower back.
- At the site of the focus of pain, a change in skin color (redness) is observed.
- Throughout the length of the limb, the patient feels pain or discomfort.
- In some cases, there is paralysis (full, partial) and numbness of the foot and lower leg.
- Body temperature is several degrees elevated and stably kept above normal for a long time.
- In the supine position, when the leg is taken to the side, the patient has an acute, shooting pain.
- There may be difficulty urinating.
- In advanced cases, trophic ulcers appear on the foot, heel or fingers, keratinization of the skin can occur, or excessive hair growth can be observed.
Sciatic nerve neuropathy causes the patient to change gait in order to reduce pain intensity. The patient tries to walk with a straight leg.
Diagnostics
Symptoms of sciatic nerve neuropathy (in ICD-10, as mentioned, code G57.0) are referred to a neurologist or vertebrologist. At the first stage, the specialist conducts an external examination and a test for the presence of a Laseg symptom. The patient is placed on the couch face up, the doctor bends the affected leg in the knee about 90 degrees and slowly straightens it. Based on the presence and intensity of pain, the size of the extension angle, the doctor draws conclusions about the degree of development of the disease. Next, diagnostic tests are prescribed.
Diagnostic Methods:
- X-ray The study is carried out in frontal and lateral projection to detect changes in the intervertebral discs.
- The most demonstrative method for diagnosing sciatic nerve neuropathy is MRI. The collected data and complete visualization of the nerve, spinal cord, vertebrae, discs and surrounding tissues allow us to identify the site of the lesion, the degree of inflammation and the development of the disease.
- Radioisotope scanning. The study is necessary to confirm or refute suspected oncology. The method is relevant for patients who have been taking corticosteroid drugs for a long time, as well as for people with HIV infection.
- Electromyography. This type of study makes it possible to assess the state of muscles, to identify the localization of the inflammatory process, to assess the degree of nerve damage. During the recovery period, electromyography helps to evaluate the speed of recovery of nerve fibers.
To obtain a complete picture of sciatic nerve neuropathy and to reach a verdict, consultation with specialized specialists is sometimes required. In such cases, they turn to a rheumatologist, vascular surgeon, dermatologist, etc.
Treatment
When a complete diagnosis is made and the symptoms of sciatic nerve inflammation are confirmed, treatment is prescribed in a comprehensive manner to eliminate manifestations of pathology and restore nerve tissue. Therapy includes the use of medications and physiotherapy.
In the stage of exacerbation of the disease, the following groups of drugs are prescribed:
- Intramuscular administration of anti-inflammatory non-steroidal drugs during the first three days from the moment of exacerbation, in the future the patient is transferred to tablets, powders, and ointments and creams for external use are prescribed (Nimesulide, Meloxicam, Ketanov, Ketonal, "Movalis", etc.).
- Muscle relaxants - relieve muscle spasm, muscle tone, reduce pain ("Baclofen", "Midokalm", etc.).
- Antioxidants - normalize nutrition and metabolism in tissues and nerve fibers (vitamins C, E, as well as copper, selenium).
- Metabolites - improve the nutrition of the roots of nerves, the nerve trunk, contribute to the restoration of motor activity and sensitivity ("Meldonium", "Inosine", "Karnitsetin", etc.).
- Vasoactive drugs - stimulate blood microcirculation in damaged tissues (nicotinic acid, etc.).
- Vitamins - a complex of B vitamins stimulates intracellular metabolism ("Combilipen", "Milgamma").
In some cases, with severe pain, the patient is blockaded by injection into the site of pain localization. The procedure is carried out by an experienced specialist in a clinic or hospital. Total anesthesia lasts at least 12 hours and no more than 3 days.
Physiotherapy and other methods
Neuropathy of the right sciatic nerve or left nerve can be treated well with physiotherapeutic procedures designed to consolidate success.
Effective methods:
- UHF - increases the permeability of the walls of blood vessels, warms up the site of damage, promotes the regeneration of damaged tissues.
- Magnetotherapy - eliminates edema, inflammation of the sciatic nerve, surrounding tissues. Promotes cell regeneration.
- Laser therapy - stimulates blood microcirculation in tissues, capillaries, reduces pain, reduces swelling.
- Electrophoresis - reduces swelling, improves blood supply to tissues. The procedure is carried out using drugs.
Physiotherapeutic manipulations are contraindicated in people with oncological, dermatological, infectious pathologies. It is impossible to conduct procedures for patients suffering from epilepsy, hypertension.
To eliminate the symptoms of inflammation of the sciatic nerve, treatment is prescribed not only during the period of exacerbation. It is recommended during the period of remission. To avoid the return of the disease or its complications, patients need to undergo preventive treatment with a certain frequency, which includes:
- Massage - to get the effect you need to go through about 10 sessions. The procedure is prescribed to improve blood flow, lymph outflow, reduce swelling, relieve muscle spasm.
- Manual therapy (according to indications) - eliminates pinching of the sciatic nerve, improves mobility in the lumbosacral, relieves muscle tone.
- Exercise therapy - physical therapy is prescribed on the recommendation of the attending physician, a set of exercises is developed individually. The purpose of physical education is to strengthen the muscle corset, maintaining the elasticity of the ligaments.
General strengthening measures are carried out in the period of stable remission. Exercise should gradually become more complex, and as the muscles strengthen, the number of repetitions increases.
Unsuccessful injections
Postinjection sciatic nerve neuropathy occurs under the influence of toxic, allergic or mechanical factors. The most commonly diagnosed damage to the nerve trunk is by an injection needle, when the injection is made not in the upper outer quadrant of the buttock, but closer to the middle or bottom of the gluteal muscle. Symptoms of the lesion may occur gradually or immediately after unsuccessful manipulation.
As the disease worsens, motor disorders are observed, pain occurs. With a complete defeat of the sciatic nerve, the foot loses the ability to move, swelling, ulcers, cyanotic color of the skin may appear, the patient is painfully stepping on the foot.
Phased treatment is aimed at restoring nerve tissue, preventing possible complications on joints, muscles, tendons, and with a shallow lesion it takes no more than 4 weeks. The range of therapeutic measures includes therapeutic exercises, hydrokinesitherapy, electrophoresis with medications (iodine, lidase), ultrasound treatment, peloid therapy, electrical stimulation, dibazole.
Traumatic lesions
Postinjection neuropathy, the consequences of deep injuries and injuries of the lower extremities relate to post-traumatic neuropathy of the sciatic nerve.
The causes of the pathology are:
- Surgery
- Injuries, injuries (including after injection).
- Strokes, bruises, prolonged nerve compression.
- Dislocations of joints, bone fractures.
Symptoms of damage in most cases are as follows:
- Violations of movement, functionality.
- Paralysis complete or partial.
- Change in sensitivity, change in temperature of the damaged limb.
- Decreased muscle tone.
- Possible neuralgia, aggravated by pain of varying severity.
Treatment of sciatic nerve neuropathy of mechanical origin is carried out by conservative methods and is developed individually. Therapy includes the following activities:
- Acupuncture.
- Hardware and drug stimulation of nerves and muscles.
- Passive forms of physiotherapy exercises.
- Reception (intramuscularly, intravenously) of B vitamins, as well as C and E.
- In some cases, surgical treatment is indicated.
Damage to the sciatic nerve rarely disables it completely, most often a certain segment of the nervous tissue suffers.
Complications after arthroplasty
Sciatic nerve neuropathy after arthroplasty occurs in less than 1% of operated patients. Pathology is the result of an improperly selected endoprosthesis, surgeon errors.
The defeat is divided into two types depending on the development mechanism:
- Ischemic - a consequence of compression of the nerve trunk by tissues injured during the operation. It appears in people with underdeveloped muscles and subcutaneous fat.
- Tractional. When the prosthesis head is inserted into the joint, the surgeon performs hip extension (traction). Excessive tensile stress leads to nerve damage.
If neuropathy occurs immediately after surgery, this indicates traction damage. The onset of symptoms of sciatic nerve neuropathy several days after surgery indicates the ischemic nature of the disease.
Patients complain of a violation of sensitivity, sometimes a burning pain appears in the foot, the gait changes. The patient cannot stand on the heel, when raising the foot, the foot sags to take a step, the patient raises his leg high. After detecting visual symptoms, a diagnosis is prescribed - radiography, electromyography.
For the treatment of sciatic nerve neuropathy of this type, it is recommended to take groups of painkillers, antispasmodic, antihypoxic drugs, membrane protectors, antiplatelet agents, biostimulants and antioxidants are also needed. Drug therapy is supplemented by therapeutic massage, a course of hyperbaric oxygenation and electroneuromyostimulation are prescribed.
ethnoscience
Traditional medicine recipes are aimed at eliminating the main symptoms of sciatic nerve neuropathy - pain and inflammation.
Effective external remedies:
- Honey massage - heat honey (300 g) in a water bath until foam appears, remove from heat, pour medical alcohol (50 g) into hot honey, stir thoroughly. Apply to rubbing the affected areas, massage with patting movements.
- Soften beeswax, roll into a cake of such a size that it completely covers the sore spot, and apply. Fix the compress, insulate with a woolen cloth on top, leave overnight.
- Cut agave leaves along and soft part attach to the site of pain localization, fix with a wet dressing.
- Baths with coniferous broth - young shoots of pine, fir, spruce (about 1 kg) pour boiling water (3 l) and boil, insist for 4 hours, strain. Pour the resulting infusion into a warm bath, take about 15 minutes before bedtime.
Reception of infusions and decoctions helps to quickly eliminate the symptoms of sciatic nerve neuropathy. Treatment with folk remedies complements medication and physiotherapy
A few recipes:
- Pour a large tablespoon of dried aspen leaves with one glass of boiling water and boil over low heat for 30 minutes. After straining and cooling, take 30 ml / 3 times a day.
- The crushed elecampane root is boiled in 200 ml of water over low heat for 5 minutes. After cooling and filtering, drink in the morning and evening, dividing the broth into two equal parts.
- Diuretic compositions normalize the metabolism, contribute to the restoration of nerve fibers (decoctions of wild rose, parsley, calendula, chamomile, etc.).
Prevention
Any active person can get sciatic nerve neuropathy. The medical history for all begins the same way - acute pain, treatment, remission. Further actions for full recovery involve preventive measures designed to prevent the reappearance of the disease and improve the health of the patient as a whole.
What will benefit:
- Sanatorium-resort treatment in specialized health resorts, where you can take a course of procedures.
- Dosed sports activities - swimming, Nordic walking, yoga, etc.
- Balanced diet.
- Compliance with wakefulness and sleep.
- It is necessary to avoid hypothermia, stress, etc.
- Normalize body weight.