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CC Sept 2017 Sciatica

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echoecho's version from 2017-12-03 05:49

Section

Question Answer
What is the largest nerve in the body?sciatica
The sciatic nerve is made up what lumbar nerve root and sacral nerve root?4th and 5th lumbar nerve root and 1st and 2nd sacral nerve roots
Sciatica pain is related to pathology somewhere along the course of the nerve that starts in the _____ and radiates along the course of the nerve?spine
Unfortunately, the term sciatic is commonly used for any back or leg symptoms, true or false?true
The most common underlying causes of sciatica are ______ _______ ______ (majority) and osteoarthritis changes?intervertebral disc rupture
Incidence is highest in the ___ to ____ year age range?30; 50
True or false? While disc pathology and OA are the most common causes, other spinal and nonspinal causes should be considered when patients present with symptoms of sciatica?true
List the 4 causes of sciatica and sciatica like symptoms?1) disc rupture 2) OA 3) synovial cysts 4) tumors
List the 6 causes of nonspinal causes of sciatica and sciatica like symptoms?1) piriformis syndrome 2) back pocket sciatica (wallet in back pocket compresses the nerve) 3) herpes zoster without the skin lesions 4) gluteal injection site trauma 5) biceps femoris pathology (hematoma, strain, tear) 6) fractures of hip and pelvis
Can the onset of sciatic pain be acute or more insidious?both
Where does the pain begin and radiates to where?1) beings in the mid to lower buttocks 2) radiates down the leg following the distribution of the affected nerve root
Why is the pain usually unilateral?because due to the underlying pathology (disc pathology and OA)
True or false? Back pain may or may not be present in patients with sciatica?true
Sensory symptoms are generally not prominent but if present, are alonged affected sensory _____?dermatomes
Muscle weakness and loss of reflexes can occur; specific deficits can help determine what nerve root is affected, give an example?loss of ankle reflex is related to S1 nerve root
Why do most cases of sciatica not require imaging?because management will not be affected by test results
Early imaging is indicated if there is concern about what?diagnoses other than disc disease and OA (e.g. tumors)
Imaging is indicated before surgical intervention, what is the preferred study as CT and plain x-rays provide less information?MRI
What is the natural course of sciatic even without treatment (conservative treatment is particularly successful)?resolution
About 1/3 of patients will have symptom resolution within ___ weeks and 3/4s will have resolution within ____ months?2; 3
Initial pain control therapy is usually with what?1) medication and 2) physical therapy
NSAIDs are often used, although a Cochrane review found that pain control with agents was not significant compared to _____?placebo
As with any meds, potential adverse effects of NSAIDS must be weighed against potential _____?benefits
Although pain from sciatic is worse with movement, patients should be encouraged to remain _____?active
*** Is there evidence that bedrest improves outcomes?no
What other medications are recommended for neuropathic pain and are often used for sciatica but evidence-based data supporting their use are lacking?Neuropathic meds = gabapentin (Neurontin), pregabalin (Lyrica); antidepressents
Most recently, a randomized, double-blind, placebo-controlled study of pregabalin found what?no significant reduction in pain intensity or improvement in other outcomes
Comment on the use of steroids?benefits of oral steroids for sciatica are NOT consistent, most show some short-term pain relief at best
Is use of opioids for sciatic encouraged?no, it is discouraged
Various physical therapy regimens have been used for sciatica, but there are insufficient data to determine _______?superiority
While long-term benefit is difficult to determine, therapy that decreases pain and allows for improved _____ certainly has a role in care?mobility
*** Did a Cochrane review find any evidence of benefit from the use of traction for LBP with sciatica?no
Is there any evidence supporting TENS, orthotics or ultrasound?no
Although there is moderate-quality evidence to support the use of acupuncture for LBP, is there any evidence to support its use with sciatica?no
While studies are conflicting, are epidural steroid injections beneficial?not beneficial, although soem benefit is for short-term pain reief
Surgery is an option for sciatic due to disc disease, what do the studies show regarding surgical intervention?surgery results in faster and better pain relief than conservative therapy but at 1 year, there is no difference (pain or disability)
List the patients who should be offered surgery?1) cauda equina syndrome 2) bladder/bowel symptoms 3) failed conservative therapy
Is it known if delaying surgery has an effect on long-term outcomes for those with muscle weakness due to nerve root compression?no
*** SUMMARY = Sciatica is most often caused by what?1) disc disease 2) osteroathritis
*** SUMMARY = Majority of patients improve with conservative therapy within ____ months?three
*** SUMMARY = While meds typically used for neuropathic pain are often prescribed, is there evidence for their benefit?no
*** SUMMARY = List patients that surgery is indicated?1) those who fail conservative therapy 2) cauda equina compression 3) bowel/bladder dysfunction
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