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Radiculopathies? What Are They?

Radiculopathies? What Are They?

by | Back Pain, Chiropractic, Chronic Back Pain, Chronic Pain, Herniated Disc, Lower Back Pain, Neck Pain, Neck Pain Treatments, Sciatica, Sciatica Nerve Pain

The spine is made of bones called vertebrae, with the spinal cord running through the spinal canal in the center. The cord is made up of nerves. These nerve roots split from the cord and travel between the vertebrae into various areas of the body. When these nerve roots become pinched or damaged, the symptoms that follow are known as, radiculopathy. El Paso, TX. Chiropractor, Dr. Alexander Jimenez breaks down�radiculopathies,�along with their causes, symptoms and treatment.

The entire length of the spine, at each level, nerves exit through holes in the bone of the spine (foramen) on each side of the spinal column. These nerves are called nerve roots, or radicular nerves and�branch out from the spine and supply different parts of the body.

Nerves exiting the cervical spine travel down through the arms, hands, and fingers. This is where neck problems affecting a cervical nerve root can cause pain, as well as, other symptoms through the arms and hands, one form of (radiculopathy). Another is low back problems that affect a lumbar nerve root. This can radiate through the leg and into the foot, another form of (radiculopathy, or sciatica), which creates leg pain and/or foot pain.

The spinal cord does not go into the lumbar spine and because the spinal canal has space in the lower back, problems in the lumbosacral region often cause nerve root problems and not a spinal cord injury. Serious conditions i.e. disc herniation or fracture in the lower back are also not likely to cause permanent loss of motor function in the legs.

  • Cervical Spine – This nerve root is named according to the Lower spinal segment that the nerve root runs between.�
  • Example – The nerve at C5-C6 level is called the C6 nerve root.
  • It’s named like this because as it exits the spine, it passes Over the C6 pedicle (a piece of bone part of the spinal segment).
  • Lumbar Spine – These nerve roots are named according to the Upper spinal segment that the nerve runs between.
  • Example – The nerve at L4-L5 level is called the L4 nerve root.
  • The nerve root is named this way because as it exits the spine it passes Under the L4 pedicle.

Two Nerve Roots

Two nerves cross each disc level

Only one exits�the spine (through the foramen) at that level.

Exiting Nerve Root –�This is the nerve root exiting the spine at a certain level.

Example: L4 nerve root exits the spine at L4-L5 level.

Traversing Nerve Root –�This nerve root goes across the disc and exits the spine at the level below.

Example: L5 nerve is the traversing nerve root at L4-L5 level, and is the exiting nerve root at L5-S1 level.

There is some confusion when a nerve root is compressed by disc herniation or other cause to refer both to the intervertebral level (where the disc is) and to the nerve root that is affected. This depends on where the disc herniation or protrusion is happening. It could impinge upon either the exiting nerve�or the traversing nerve.

If The Traversing Nerve Is Affected

Lumbar Radiculopathy

In the lumbar spine, there is a weak area in the disc space right in front of the traversing nerve root, so lumbar discs tend to herniate or leak out and impinge on the traversing nerve.

If The Exiting Nerve Is Affected

Cervical Radiculopathy

The opposite is true in the neck. In the cervical spine, the disc tends to herniate to the side, rather than toward the back and the side. If the disc material herniates to the side, it will compress or impinge the exiting nerve root.

Radiculopathy & Sciatica

Nerve root goes by another name Radicular Nerve, and when a herniated or prolapsed disc presses on a radicular nerve, this is referred to as a radiculopathy. A medical physician might say there is herniated disc at L4-L5, which creates an L5 radiculopathy or an L4 radiculopathy. It all depends on where the disc herniation occurs (the side or the back of the disc) and which nerve is affected. And the term for radiculopathy in the low back is the ever famous Sciatica.

Radiculopathy

  • A pinched nerve can occur at different areas of the spine (cervical, thoracic or lumbar).
  • Common causes are narrowing of the hole where the� nerve roots exit, which can result from stenosis, bone spurs, disc herniation and other conditions.
  • Symptoms vary but often include pain, weakness, numbness and tingling.
  • Symptoms can be managed with nonsurgical treatment, but minimal surgery can also help.

Prevalence & Pathogenesis

radiculopathies chiropractic care el paso tx.

  • A herniated disc can be defined as herniation of the nucleus pulposus through the fibers of the annulus fibrosus.
  • Most disc ruptures occur during the third and fourth decades of life while the nucleus pulposus is still gelatinous.
  • The most likely time of day associated with increased force on the disc is the morning.
  • In the lumbar region, perforations usually arise through a defect just lateral to the posterior midline, where the posterior longitudinal ligament is weakest.

radiculopathies chiropractic care el paso tx.

Epidemology

radiculopathies chiropractic care el paso tx.Lumbar Spine:

  • Symptomatic lumbar disc herniation occurs during the lifetime of approximately 2% of the general population.
  • Approximately 80% of the population will experience significant back pain during the course of a herniated disc.
  • The groups at greatest risk for herniation of intervertebral discs are younger individuals (mean age of 35 years)
  • True sciatica actually develops in only 35% of patients with disc herniation.
  • Not infrequently, sciatica develops 6 to 10 years after the onset of low back pain.
  • The period of localized back pain may correspond to repeated damage to annular fibers that irritates the sinuvertebral nerve but does not result in disc herniation.

Epidemology

Cervical Spine:

  • The average annual incidence of cervical radiculopathies is less than 0.1 per 1000 individuals.
  • Pure soft disc herniations are less common than hard disc abnormalities (spondylosis) as a cause of radicular arm pain.
  • In a study of 395 patients with nerve root abnormalities, radiculopathies occurred in the cervical and lumbar spine in 93 (24%) and 302 (76%), respectively.

Pathogenesis

  • Alterations in intervertebral disc biomechanics and biochemistry over time have a detrimental effect on disc function.
  • The disc is less able to work as a spacer between vertebral bodies or as a universal joint.

Pathogenesis – LUMBAR SPINE

radiculopathies chiropractic care el paso tx.

  • The two most common levels for disc herniation are L4-L5 and L5-S1, which account for 98% of lesions; pathology can occur at L2-L3 and L3-L4 but is relatively uncommon.
    Overall, 90% of disc herniations are at the L4-L5 and L5-S1 levels.
  • Disc herniations at L5-S1 will usually compromise the first sacral nerve root, a lesion at the L4-L5 level will most often compress the fifth lumbar root, and herniation at L3-L4 more frequently involves the fourth lumbar root.

radiculopathies chiropractic care el paso tx.

radiculopathies chiropractic care el paso tx.

radiculopathies chiropractic care el paso tx.

  • Disc herniation may also develop in older patients.
  • Disc tissue that causes compression in elderly patients is composed of the annulus fibrosus and and portions of the cartilaginous endplate (hard disc.)
    The cartilage is avulsed from the vertebral body.
  • Resolution of some of the compressive effects on neural structures requires resorption of the nucleus pulposus.

radiculopathies chiropractic care el paso tx.

  • Disc resorption is part of the natural healing process associated with disc herniation.
  • The enhanced ability to resorb discs has the potential for resolving clinical symptoms more rapidly.
  • Resorption of herniated disc material is associated with a marked increase in infiltrating macrophages and the production of matrix metalloproteinases (MMPs) 3 and 7.
  • Nerlich and associates identified the origins of phagocytic cells in degenerated intervertebral discs.
  • The investigation identified cells that are transformed local cells rather than invaded macrophages.
  • Degenerative discs contain the cells that add to their continued dissolution.

radiculopathies chiropractic care el paso tx.

Pathogenesis – CERVICAL SPINE

  • In the early 1940s, a number of reports appeared in which cervical intervertebral disc herniation with radiculopathies was described.
  • There is a direct correlation between the anatomy of the cervical spine and the location and pathophysiology of disc lesion.

radiculopathies chiropractic care el paso tx.

  • The eight cervical nerve roots exit via intervertebral foramina that are bordered anteromedially by the intervertebral disc and posterolaterally by the zygapophyseal joint.
  • The foramina are largest at C2-C3 and decrease in size until C6-C7.
  • The nerve root occupies 25% to 33% of the volume of the foramen.
  • The C1 root exits between the occiput and the atlas (C1)
  • All lower roots exit above their corresponding cervical vertebrae (the C6 root at the C5-C6 interspace), except C8, which exits between C7 and T1.
  • A differential growth rate affects the relationship of the spinal cord and nerve roots and the cervical spine.

radiculopathies chiropractic care el paso tx.

  • Most acute disc herniations occur posterolaterally and in patients around the forth decade of life, when the nucleus is still gelatinous.
  • The most common areas of disc herniations are C6-C7 and C5-C6.
  • C7-T1 and C3-C4 disc herniations are infrequent ( less than 15 %).
  • Disc herniation of C2-C3 is rare.
  • Patients with upper cervical disc protrusions in the C2-C3 region have symptoms that include suboccipital pain, loss of hand dexterity, and paresthesias over the face and unilateral arm.
  • Unlike lumbar herniated discs, cervical herniated discs may cause myelopathy in addition to radicular pain because of the anatomy of the spinal cord in the cervical region.
  • The uncovertebral prominences play a role in the location of ruptured discs material.
  • The uncovertebral joint tends to guide extruded disc material medially, where cord compression may also occur.

radiculopathies chiropractic care el paso tx.

radiculopathies chiropractic care el paso tx.

  • Disc herniations usually affect the nerve root numbered most caudally for the given disc level; for example, the C3 � C4 disc affects the fourth cervical nerve root; C4- C5, the fifth cervical nerve root; C5 � C6, the sixth cervical nerve root; C6 � C7, the seventh cervical nerve root; and C7 � T1, the eighth cervical nerve root.

radiculopathies chiropractic care el paso tx.

  • Not every herniated disc is symptomatic.
  • The development of symptoms depends on the reserve capacity of the spinal canal, the presence of inflammation, the size of the herniation, and the presence of concomitant disease such as osteophyte formation.
  • In disc rupture, protrusion of nuclear material results in tension on the annular fibers and compress?on of the dura or nerve root causing pain.
  • Also important is the smaller size of the sagittal diameter, the bony cervical spinal canal.
  • Individuals in whom a cervical herniated disc causes motor dysfunction have a complication of cervical disc herniation if the spinal canal is stenotic.

Clinical History – LUMBAR SPINE

  • Clinically, the patient�s major complaint is a sharp, lancinating pain.
  • In many cases there may be a previous history of intermittent episodes of localized low back pain.
  • The pain not only in the back but also radiates down the leg in the anatomic distribution of the affected nerve root.
  • It will usually be described as deep and sharp and progressing from above downward in the involved leg.
  • Its onset may be insidious or sudden and associated with a tearing or snapping sensations of the spine.
  • Occasionally, when sciatica develops, the back pain may resolve because once the annulus has ruptured, it may no longer be under tension.
  • Disc herniation occurs with sudden physical effort when the trunk is flexed or rotated.
  • On occasion, patients with L4-L5 disc herniation have groin pain. In a study of 512 lumbar disc patients, 4.1% had groin pain.
  • Finally, the sciatica may vary in intensity; it may be so severe that patients will be unable to ambulate and they will feel that their back is “locked”.
  • On the other hand, the pain may be limited to a dull ache that increases in intensity with ambulation.
  • Pain is worsened in the flexed position and relieved by extension of the lumbar spine.
  • Characteristically, patients with herniated discs have increased pain with sitting, driving, walking, couching, sneezing, or straining.

Clinical History – CERVICAL SPINE

  • Arm pain, not neck pain, is the patient� s major complaint.
  • The pain is often perceived as starting in the neck area and then radiating from this point down to shoulder, arm and forearm and usually into the hand.
  • The onset of the radicular pain is often gradual, although it can be sudden and occur in association with a tearing or snapping sensation.
  • As time passes, the magnitude of the arm pain clearly exceeds that of the neck or shoulder pain.
  • The arm pain may also be variable in intensity and preclude any use of the arm; it may range from severe pain to a dull, cramping ache in the arm muscles.
  • The pain is usually severe enough to awaken the patient at night.
  • Additionally, a patient may complain of associated headaches as well as muscle spasm, which can radiate from the cervical spine to below the scapulae.
  • The pain may also radiate to the chest and mimic angina (pseudoangina) or to the breast.
  • Symptoms such as back pain, leg pain, leg weakness, gait disturbance, or incontinence suggest compression of the spinal cord (Myelopathy).

Physical Examination – LUMBAR SPINE

radiculopathies chiropractic care el paso tx.

  • Physical examination will demonstrated a decrease in range of motion of the lumbosacral spine, and patients may list to one side as they try to bend forward.
  • The side of the disc herniation typically corresponds to the location of the scoliotic list.
  • However, the specific level or degree of herniation does not correlate with the degree of list.
  • On ambulation, patients walk with an antalgic gait in which they hold the involved leg flexed so that they put as little weight as possible on the extremity.

radiculopathies chiropractic care el paso tx.

  • Neurologic Examination:
  • The neurologic examination is very important and may yield objective evidence of nerve root compression (We should evaluate of reflex testing, muscle power, and sensation examination of the patient).
  • In addition, a nerve deficit may have little temporal relevance because it may be related to a previous attack at a different level.
  • Compression of individual spinal nerve roots results in alterations in motor, sensory, and reflex function.
  • When the first sacral root is compressed, the patient may have gastrocnemius-soleus weakness and be unable to repeatedly raise up on the toes of that foot.
  • Atrophy of the calf may be apperent, and the ankle (Achilles) reflex is often diminished or absent.
  • Sensory loss, if present, is usually confined to the posterior aspect of the calf and the lateral side of the foot.

radiculopathies chiropractic care el paso tx.

  • Involvement of the fifth lumbar nerve root can lead to weakness in extension of the great toe and, in a few cases, weakness of the everters and dorsiflexors of the foot.
  • A sensory deficit can appear over the anterior of the leg and the dorsomedial aspect of the foot down to the big toe

radiculopathies chiropractic care el paso tx.

  • With compression of the fourth lumbar nerve root, the quadriceps muscle is affected; the patient may note weakness in knee extension, which is often associated with instability.
  • Atrophy of the thigh musculature can be marked. Sensory loss may be apparent over the anteromedial aspect of the thigh, and the patellar tendon reflex can be diminished.

radiculopathies chiropractic care el paso tx.

 

radiculopathies chiropractic care el paso tx.

  • Nerve root sensitivity can be elicited by any method that creates tension.
  • The straight leg-raising (SLR)test is the one most commonly used.
  • This test is performed with the patient supine.

Physical Examination – CERVICAL SPINE

Neurologic Examination:
  • A neurologic examination that shows abnormalities is the most helpful aspect of the diagnostic work-up, although the examination may remain normal despite a chronic radicular pattern.
  • The presence of atrophy helps document the location of the lesion, as well as its chronicity.
  • The presence of subjective sensory changes is often difficult to interpret and requires a coherent and cooperative patient to be of clinical value.

radiculopathies chiropractic care el paso tx.

  • When the third cervical root is compressed, no reflex change and motor weakness can be identified.
  • The pain radiates to the back of the neck and toward the mastoid process and pinna of the ear.
  • Involvement of the fourth cervical nerve root leads to no readily detectable reflex changes or motor weakness.
  • The pain radiates to the back of the neck and superior aspect of the scapula.
  • Occasionally, the pain radiates to the anterior chest wall.
  • The pain is often exacerbated by neck extension.
  • Unlike the third and the fourth cervical nerve roots, the fifth through eighth cervical nerve roots have motor functions.
  • Compression of the fifth cervical nerve root is characterized by weakness of shoulder abduction, usually above 90 degree, and weakness of shoulder extension.
  • The biceps reflexes are often depressed and the pain radiates from the side of the neck to the top of the shoulder.
  • Decreased sensation is often noted in the lateral aspect of the deltoid, which represents the autonomous area of the axillary nerve.

radiculopathies chiropractic care el paso tx.

  • Involvement of the sixth cervical nerve root produces biceps muscles weakness as well as diminished brachioradial reflex.
  • The pain again radiates from the neck down the lateral aspect of the arm and forearm to the radial side of hand (index finger, long finger, and thumb).
  • Numbness occurs occasionally in the tip of the index finger, the autonomous area of the sixth cervical nerve root.

radiculopathies chiropractic care el paso tx.

  • Compression of the seventh cervical nerve root produces reflex changes in the triceps jerk test with associated loss of strength in the triceps muscles, which extend the elbow.
  • The pain from this lesion radiates from the lateral aspect of the neck down the middle of the area to the middle finger.
  • Sensory changes occur often in the tip of the middle finger, the autonomous area for the seventh nerve.
  • Patients should also be tested for scapular winging, which may occur with C6 or C7 radiculopathies.

radiculopathies chiropractic care el paso tx.

  • Finally, involvement of the eighth cervical nerve root by a herniated C7-T1 disc produces significant weakness of the intrinsic musculature of the hand.
  • Such involvement can lead to rapid atrophy of the interosseous muscles because of the small size of these muscles.
  • Loss of the interossei leads to significant loss of fine hand motion.
  • No reflexes are easily found, although the flexor carpi ulnaris reflex may be decreased.
  • The radicular pain from the eighth cervical nerve root radiates to the ulnar border the hand and the ring and little fingers.
  • The tip of the little finger often demonstrates diminished sensation.

radiculopathies chiropractic care el paso tx.

  • Radicular pain secondary to a herniated cervical disc may be relieved by abduction of the affected arm.
  • Although these signs are helpful when present, their absence alone does not rule out a nerve root lesion.

Laboratory Data

radiculopathies chiropractic care el paso tx.

  • Medical screening laboratory test (blood counts, chemistry panels erythrocyte sedimentation rate [ESR]) are normal in patients with a herniated disc.
  • Electro diagnostic Testing
  • Electromyography(EMG)is an electronic extension of the physical examination.
  • The primary use of EMG is to diagnose radiculopathies in cases of questionable neurologic origin.
  • EMG findings may be positive in patients with nerve root impingement.

Radiographic Evaluation – LUMBAR SPINE

  • Plain x-rays may be entirely normal in a patient with signs and symptoms of nerve root impingement.
  • Computed Tomography
  • Radigraphic evaluation by CT scan may demonstrate disc bulging but may not correlate with the level of nerve damage.
  • Magnetic Resonance Imaging
  • MR imaging also allows visualization of soft tissues, including discs in the lumbar spine.
  • Herniated discs are easily detected with MR evaluation.
  • MR imaging is a sensitive technique for the detection of far lateral and anterior disc herniations.

Radiographic Evaluation – CERVICAL SPINE

  • X-rays
  • Plain x-rays may be entirely normal in patients wit han acute herniated cervical disc.
  • Conversely,�70% of asymptomatic women and 95% of asymptomatic men between the ages of 60 and 65 years have evidence of degenerative disc disease on plain roentgenograms.
  • Views to be obtained include anteroposterior, lateral, flexion, and extension.
radiculopathies chiropractic care el paso tx.

radiculopathies chiropractic care el paso tx.

  • Computed Tomography
  • CT permits direct visualization of compression of neural structures and is therefore more precise than myelography.
  • Advantages of CT over myelography include better visualization of lateral abnormalities such as foraminal stenosis and abnormalities caudal to the myelographic block, less radiation exposure, and no hospitalization.
  • Magnetic Resonance
  • MRI allows excellent visualization of soft tissues, including herniated discs in the cervical spine.
  • The test is noninvasive.
  • In a study of 34 patients with cervical lesions, MRI predicted 88% of the surgically proven lesions versus 81% for myelography-CT, 58% for myelography, and 50% for CT alone.

Differential Diagnosis – LUMBAR SPINE

  • The initial diagnosis of a herniated disc is ordinarily made on the basis of the history and physical examination.
  • Plain radiographs of the lumbosacral spine will rarely add to the diagnosis but should be obtained to help rule out other causes of pain such as infection or tumor.
  • Other tests such as MR, CT, and myelography are confirmatory by nature and can be misleading when used as screening tests.

Spinal Stenosis

  • Patient with spinal stenosis may also suffer from back pain that radiates to the lower extremities.
  • Patients with spinal stenosis tend to be older than those in whom herniated discs develop.
  • Characteristically, patients with spinal stenosis experience lower extremity pain (pseudoclaudication=neurogenic claudication) after walking for an unspecified distance.
  • They also complain of pain that is exacerbated by standing or extending the spine.
  • Radiographic evaluation is usually helpful in differentiating individuals with disc herniation from those with bony hypertrophy associated with spinal stenosis.
  • In a study of 1,293 patients, lateral spinal stenosis and herniated intervertebral discs coexisted in 17.7% of individuals.
  • Radicular pain may be caused by more than one pathologic process in an individual.

Facet Syndrome

  • Facet syndrome is another cause of low back pain that may be associated with radiation of pain to structures outside the confines of the lumbosacral spine.
  • Degeneration of articular structures in the facet joint causes pain to develop.
  • In most circumstances, the pain is localized over the area of the affected joint and is aggravated by extension of the spine (standing).
  • A deep , ill-defined, aching discomfort may also be noted in the sacroiliac joint, the buttocks, and the legs.
  • The areas of sclerotome affected show the same embryonic origin as the degenerated facet joint.
  • Patients with pain secondary to facet joint disease may have relief of symptoms with apophyseal injection of a long-acting local anesthetic.
  • The true role of facet joint disease in the production of back and leg pain remains to be determined.
  • Other mechanical causes of sciatica include congentenial abnormalites of the lumbar nerve roots, external compression of the sciatic nerve (wallet in a back pants pocket), and muscular compression of the nerve (piriformis syndrome).
  • In rare circumstances, cervical or thoracic lesion should be considered if the lumbar spine is clear of abnormalities.
  • Medical causes of sciatica (neural tumors or infections, for example) are usually associated with systemic symptoms in addition to nerve pain in a sciatic distribution.

Differential Diagnosis – CERVICAL SPINE

  • No diagnostic criteria exist for the clinical diagnosis of a herniated cervical disc.
  • The provisional diagnosis of a herniated cervical disc is made by the history and physical examination.
  • The plain x-ray is usually nondiagnostic, although occasionally disc space narrowing at the suspected interspace or foraminal narrowing on oblique films is seen.
  • The value of x-rays is to exclude other causes of neck and arm pain, such as infection and tumor.
  • MR imaging and CT-myelography are the best confirmatory examinations for disc herniation.
  • Cervical disc herniations may affect structures other than nerve roots.
  • Disc herniation may cause vessel compression (vertebral artery) associated with vertebrobasilar artery insufficiency and be manifested as blurred vision and dizziness.

radiculopathies chiropractic care el paso tx.

  • Other mechanical causes of arm pain should be excluded.
  • The most common is some form of compression on a peripheral nerve.
  • Such compression can occur at the elbow, forearm, or wrist. An example is compression of the median nerve by the carpal ligament leading to carpal tunnel syndrome.
  • The best diagnostic test to rule out these peripheral neuropathies is EMG.
  • Excessive traction on the arm secondary to heavy weights may cause radicular pain without disc compression of nerve roots.
  • Spinal cord abnormalities must be considered if signs of myelopathy are present in conjunction with radiculopathies.
  • Spinal cord lesions such as syringomyelia are identified by MRI, and motor neuron disease is identified by EMG.
  • Multiple sclerosis should be considered in a patient with radiculopathies if the physical signs indicate lesions above the foramen magnum (optic neuritis).
  • In very rare circumstances, lesions of the parietal lobe corresponding to the arm can mimic the findings of cervical radiculopathies.
Sciatica and Radicular Back and Leg Pain in El Paso, TX

Sciatica and Radicular Back and Leg Pain in El Paso, TX

by | Back Pain, Chiropractic, Sciatica, Sciatica Nerve Pain, Treatments

If you have lower back or buttocks pain which runs into your thigh or past the knee to one leg and foot, a healthcare professional may diagnose your symptoms as sciatica. Sciatica is a medical term used to describe painful sensations caused by the compression or impingement of the sciatic nerve. This compression is normally caused by a disc herniation or a bone spur pressing on one of the nerves in the lower back.

 

Sensations, or unusual feelings, could include numbness, tingling, pins and needles, and sometimes pain referred to as electric-shock-like. Determined by the individual nerve that is affected, pain may radiate only into the buttocks or all the way down to the foot.

 

Sciatica pain generally radiates along the length of the sciatic nerve, the longest and largest nerve in the human body, usually from the lower back, down the buttocks, and into the thigh and leg as well as the foot. One hallmark of classic sciatica is when the painful symptoms are felt beneath the knee and sometimes down into the foot and great toe. Usually, sciatica only affects one side of the body, however, it may occasionally affect both sides of the body.

 

Radicular Pain or Radiculopathy

 

Radicular pain, or radiculopathy, are different terms used to describe similar symptoms. Your healthcare professional may commonly utilize these terms interchangeably while discussing your sciatica. Radiculopathy is pain and/or an adverse sensation that travels past the affected site, along the length of a nerve. When a spinal nerve root is compressed, pinched or injured, it may become inflamed. Common conditions which could cause this kind of problem are spinal stenosis, foraminal stenosis or herniated discs.

 

What to Expect from a Sciatica Diagnosis

 

In order to determine the proper diagnosis of your sciatica symptoms, a healthcare professional may ask a series of questions, for instance:

 

  • When did the pain begin?
  • Where do you feel the pain?
  • What activities worsen or reduce pain and symptoms?
  • Does the pain go all the way down your leg or does it stop at the knee?
  • Is there weakness or tingling in your thighs or feet?
  • How severe is your pain, on a scale of 1 to 10? (10 being the worse pain possible)

 

The healthcare professional may conduct a straight-leg test to find out whether you’ve got irritation or inflammation on a nerve. In order to perform this evaluations, you lie on your back while the doctor lifts each leg. When lifting a leg causes, or generates sciatic-like pain and sensations, you might have a bulging or ruptured disc, best known as a disc herniation.

 

Furthermore, the healthcare professional may ask you to walk as you normally do, then on your heels and next on your toes. This enables the physician to confirm your balance and aspects of lower-body strength. Compression or impingement of the sciatic nerve may cause muscle fatigue in the foot that will be revealed by these tests and evaluations. During your examination, your healthcare professional will:

 

  • Look at your position and range of movement
  • Note any movement that causes pain
  • Examine the curvature and alignment of your spine
  • Feel for muscle strain
  • Assess your sensation
  • Test your reflexes and muscle strength

 

Your doctor may order a plain x-ray, CT scan or MRI to help see the source of your sciatica more clearly. The CT scan or MRI provides the doctor with several snapshots of your spine, and will help confirm a suspected diagnosis. The findings of an imaging test are compared to the information that the doctor gathers during the taking of your medical history, and physical and neurological examination outcomes. An accurate identification is one of the very first steps in determining the best treatment options.

 

If it’s not Sciatica, What Else Could it Be?

 

Only a healthcare professional can tell for sure if your symptoms are sciatica or not. There are many complex structures in the spine which can result in similar kinds of pain. For instance, the joint between the pelvic and sacrum, or the sacroiliac joint, or SI joint, which is the smallest portion of the spine, may lead to pain from the buttock in the case of injury or due to an aggravated condition. You may also feel sciatica-like pain and discomfort if you sprain a very low back facet joint, which are the connecting joints at the back region of the spine. A tear in a disk can lead to pain down to the leg. The hip joint can occasionally trigger pain at the thigh as well. It’s essential to seek proper medical attention to assess the source of your symptoms.

 

Sciatica Treatment

 

Treatments for sciatica pain are diverse and there are lots of options to choose from. While sciatic nerve pain and radicular pain symptoms may resolve with the use of many traditional and alternative treatment options, severe cases may require surgery. Normally, some middle ground of these two extremes is the answer for curing sciatica.

 

Sciatica usually may be treated nonsurgically with short (24 to 48 hours) bed rest and pain relievers like aspirin or acetaminophen. In some cases, the physician may prescribe drugs and/or medications that relieves nerve pain, such as gabapentin. Oral steroids are another commonly used treatment to calm pain down. Typically, patients with sciatica feel better over time, generally in a few weeks. If pain persists, however, injections might be discussed. Muscle cramps, which might accompany sciatica symptoms, might be treated with heat or cold. Your physician will tell you to take brief walks, and might prescribe physical therapy. Once you recover, your doctor may also give you exercises to strengthen your back.

 

Can Chiropractic Care Treat Sciatica?

 

Chiropractic care is one of the top treatment options used for sciatica pain. Utilizing a variety of methods and techniques, chiropractic care doesn’t simply reduce the symptoms, it can ultimately fix the health issues associated with sciatica and prevent further circumstances of the collection of symptoms.

 

A good chiropractic care regimen might include spinal adjustments and manual manipulations, passive therapies, spinal decompression, massage therapy, and physical therapy to help reduce pain and correct the underlying problem causing it. A great chiropractic solution is going to be a plan which entails many or all of the above mentioned remedies as determined by your personal needs and recovery timeline. Furthermore, a chiropractor may recommend a series of appropriate stretches and exercises to help speed up the recovery process and promote a long-lasting recovery so you can live a pain-free life.

 

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Dr. Alex Jimenez’s Insight

Sciatica is a medical term used to describe a collection of symptoms, including, pain, numbness or tingling sensations, caused by the compression or irritation of the sciatic nerve in the lower back. Although symptoms of sciatic nerve pain, or sciatica, are commonly concentrated in the lower back, radiating pain or radiculopathy may sometimes occur along the length of the sciatic nerve. A bulging or herniated disc is one of the most prevalent health issues which lead to sciatica. It’s essential to receive a proper diagnosis of any painful symptoms in order to follow-up with the best treatment options. Chiropractic care can help treat sciatica through the use of spinal adjustment and manual manipulations, among other treatment modalities, by carefully restoring the original alignment of the spine and reducing nerve compression and irritation associated with sciatic nerve pain.

 

If you believe that you are suffering from sciatic nerve pain, then consider the chiropractic care alternative solution. Many chiropractors can help by building a customized restoration plan around your requirements and goals. With years of experience, friendly employees, and innovative equipment, the proper chiropractor will get you back to normal the natural way. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

Curated by Dr. Alex Jimenez

 

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Additional Topics: Sciatica

Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.

 

 

 

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EXTRA IMPORTANT TOPIC: Chiropractor Sciatica Symptoms

 

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Abatement of Radiculopathy Symptoms after Chiropractic Care

Abatement of Radiculopathy Symptoms after Chiropractic Care

by | Chiropractic, Spine Care

Title: Abatement of radiculopathy clinical signs and symptoms after chiropractic treatment in an older patient with trauma induced posterolateral disc herniation, superimposed on an underlying disc bulge.

Abstract: Objective: To examine the concomitant clinical diagnosis of a lumbar disc bulge and lumbar disc herniation at the same spinal level, in an older traumatically injured patient with radicular symptoms. Diagnostic studies include physical examination, including orthopedic and neurological examination, lumbar MRI without contrast, and plain film x-rays. Treatments included low force instrument adjusting without manual manipulation, diversified chiropractic manipulation, flexion-distraction treatment, intersegmental traction, electric muscle stimulation, ice, heat and massage/trigger point therapy. The patient�s outcome was very good and resulted in complete abatement of initial L5 paresthesia and radiating symptoms into the left leg, although mild lower back pain remained upon discharge from active treatment.

Introduction: A 63 year old, 6� 0�, 193lbs., male was seen for a chief complaint of lower back pain radiating into the left leg with numbness in the dorsum of the left foot which started immediately following a motor vehicle accident with a frontal impact. During the collision, he reported his right knee struck the dashboard and his head struck the ceiling of his vehicle causing him to briefly lose consciousness. The patient additionally reported immediate neck and right knee pain. He was taken via ambulance to the hospital where he was evaluated, x-rayed, given medications and released the same day. He was unable to work as a bailiff in a courthouse due to worsening pain and after 3 days sought treatment in my office.

The patient noted that prior to the accident he did not have any physical limitations and that he played soccer weekly. He was observed to have a trim, fit build. He reported no prior motor vehicle accidents or other serious injury. He reported no previous neck or lower back pain and denied the use of alcohol, tobacco and illicit drugs.

Clinical Findings After Treatment

Lasague�s, Braggard�s and Kemps orthopedic testing was positive on the left and lumbar motion was decreased approximately 60% collectively. Lasague�s and Braggard�s revealed an increase in radiating pain into the left leg and Kemps was positive bilaterally for pain into the left lower extremity. These orthopedic tests were positive indicating nerve root irritation. Dermatomal evaluation revealed a decreased sensation in the dorsum of the left foot representing the L5 dermatome. Motor evaluation revealed a weakness when attempting to walk on the heel of the left foot and weakness of the left extensor hallicus longus muscle, again indicating possible L5 nerve root compromise. Lumbar x-rays revealed a severe decrease of the normal lumbar lordosis, mild L3-L4 spondylosis (arthritis) and a posterior misalignment of L4 in relation to L5. The patient�s review of systems, surgical and family history were all unremarkable as reported.

Therapeutic Focus and Assessment: A non-contrast lumbar spine MRI was ordered immediately with 2 mm slice thickness and no gap in between slices on a 1.5 Tesla machine for optimal visualization of pathology due to the clinical presentation of left L5 nerve root compression. Lumbar MRI�s revealed a L4-L5 broad-based left posterolateral disc herniation superimposed on an underlying disc bulge with severe left lateral recess narrowing, compressing the descending left L5 nerve root.

Note: the findings of a disc bulge AND disc herniation at the same spinal level do not contradict each other. Patients often have an underlying disc bulge (degenerative thinning of the outer fibers (annulus) of the disc causing �bulging�). When subject to trauma, a focal displacement of disc material through a tear in the annular fibers, disc herniation, then occurs through the thinned annulus of the bulging disc. Further, a bulging disc is actually more likely to herniate with trauma due to the thinning of the annulus than a normal healthy disc.

��������� Definition �Bulging disc: A disc in which the contour of the outer anulus extends, or appears to extend, in the horizontal (axial) plane beyond the edges of the disc space, over greater than 50% (180 degrees) of the circumference of the disc and usually less than 3mm beyond the edges of the vertebral body apophyses. (Ref. 2)

��������� Definition – Herniated disc: Localized displacement of disc material beyond the normal margins of the intervertebral disc space. (Ref. 2)

Again, the key distinction is the localized (aka focal displacement) of disc material that differentiates a herniated disc from a bulging disc. Or stated this way,�The bulging disk is defined as a disk that extends diffusely beyond the adjacent vertebral body margins in all directions� (Ref. 1)

 

Follow-up and Outcomes After Chiropractic

 

Upon discovery of a L4-L5 posterolateral disc herniation compressing the left L5 nerve root finding on MRI evaluation, the patient was referred for neurologic consult. The neurologist diagnosed a left L4-L5 radiculopathy after a positive lower extremity EMG/NCV study was performed.

Radiculopathy is a general term used to describe any disease of the nerve roots. In this case, the cause of the radiculopathy was a traumatically induced lumbar posterolateral disc herniation.

Definition � Radiculopathy: Sometimes referred to as a pinched nerve, it refers to compressionof the nerve root – the part of a nerve between vertebrae. This compression causes pain to beperceived in areas to which the nerve leads.(Ref. 3)

The patient underwent approximately 5 months of active chiropractic treatment after which an ordered gap in treatment of approximately 7 weeks occurred. After the gap in treatment, the patient reported they continued to experience no remaining radicular symptoms and re-evaluation showed no remaining clinical findings consistent with radiculopathy. However, the patient did report continuing to experience mild, intermittent lower back pain.

DISCUSSION: It is appropriate to immediately order MRI imaging in patients with a history of trauma leading to sudden onset of obvious clinical signs and symptoms of radiculopathy to ascertain an accurate diagnosis, prognosis and treatment plan. Is it important to understand the difference between herniated and bulging disc findings on MRI evaluation and that herniation can and does occur after a pre-existing disc bulge at the same spinal level. The patient in this case experienced immediate onset of radicular symptoms after trauma and was promptly evaluated with a lumbar MRI. The lumbar MRI confirmed a disc herniation compressing the left L5 nerve root as well as an underlying disc bulge.� EMG testing confirmed the radiculopathy diagnosis at L4-L5 on the left. Chiropractic treatment resulted in a very favorable outcome aided by an accurate diagnosis.

SUMMARY: Lumbar posterolateral disc herniation (interestingly, the most common type of disc herniation � Ref. 4) can affect a lumbar nerve root, causing radiculopathy. Further, �The stress of annulus circumference is higher at the posterolateral region than that of other regions of annulus circumference� � (Ref. 5). I report a case of a healthy 64 year old male who presented with lower back pain radiating into the left leg with no relevant personal or family history or previous trauma, after a front impact collision while driving in which his right knee struck the dashboard. The patient showed immediate clinical signs and symptoms of lumbar disc herniation and left L5 radiculopathy. A lumbar MRI without contrast was ordered immediately and revealed a L4-L5 left posterolateral disc herniation superimposed on an underlying disc bulge, compressing the left L5 nerve root. Subsequent EMG testing confirmed a left L4-L5 radiculopathy. The diagnosis of herniation and disc bulge does not mean the herniation was pre-existing, as bulging discs are a risk factor for disc herniation due to a thinner, weaker annulus. The patient’s history of no previous trauma and sudden onset of lower back pain radiating into the left leg, confirm the traumatic cause of the posterolateral disc herniation. Conservative chiropractic treatment was effective at eliminating all radicular signs and symptoms, even after an approximate 2 month gap in active treatment. Chiropractic care has been shown to be both safe and effective in treating patients with disc herniation and accompanying radicular symptoms. (Ref. 6, 7, 8, that can be reviewed for further study and investigation)

Informed consent: The patient provided a signed informed consent.

Competing Interests: There are no competing interests writing this case report.

De-Identification: All patient related data has been removed from this case report.

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
References:

  1. Milette PC. The proper terminology for reporting lumbar intervertebral disk disorders. AJNR Am J Neuroradiol 1997;18:1859-66.
  1. David F. Fardon, MD, Alan L. Williams, MD, Edward J. Dohring, MD. Lumbar disc nomenclature: version 2.0 Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The Spine Journal 14 (2014) 2525�2545
  1. http://medical-dictionary.thefreedictionary.com/radiculopathy
  1. Gopalakrishnan N1, Nadhamuni K2, Karthikeyan T3 Categorization of Pathology Causing Low Back Pain using Magnetic Resonance Imaging (MRI) J ClinDiagn Res. 2015 Jan;9(1):TC17-20.
  2. Guo LX, Teo EC. Influence prediction of injury and vibration on adjacent components of spine using finite element methods. J Spinal Disord Tech. 2006 Apr;19(2):118-24.
  1. Leeman S., Peterson C., Schmid C., Anklin B., Humphreys B., (2014) Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging-Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low Amplitude, Spinal Manipulation Therapy: A Prospective Observational Cohort Study With One-Year Follow Up, Journal of Manipulative and Physiological Therapeutics, 37 (3)155-63
  1. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiscectomy for sciatica? A propective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33
  1. Whedon, J. M., Mackenzie, T.A., Phillips, R.B., & Lurie, J.D. (2014). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69. Spine, �(Epub ahead of print) 1-33.

 

Additional Topics: Chiropractic Helps Patients Avoid Back Surgery

Back pain is a common symptom which affects or will affect a majority of the population at least once throughout their lifetime. While most back pain cases may resolve on their own, some instances of the pain and discomfort can be attributed to more serious spinal conditions. Fortunately, a variety of treatment options are available for patients before considering spinal surgical interventions. Chiropractic care is a safe and effective, alternative treatment option which helps carefully restore the original health of the spine, reducing or eliminating spinal misalignment which may be causing back pain.

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