GPAtlas🧭 When to suspect
Sciatica (lumbosacral radiculopathy) is leg pain arising from irritation or compression of a lumbosacral nerve root – most often by a herniated disc, but also by spinal stenosis or foraminal narrowing.
• The cardinal feature is unilateral leg pain that is worse than any accompanying back pain and radiates below the knee in a dermatomal distribution.
• The pain is typically neuropathic in quality – sharp, shooting, burning, or "electric shock"-like.
• It is often accompanied by paraesthesia, numbness, or weakness in the same leg.
Suspect sciatica when leg pain dominates over back pain, follows a nerve-root distribution, and is aggravated by coughing, sneezing, or sitting.
• The diagnosis is clinical.
• The two essential primary-care tasks are to recognise the radicular pattern and, at every contact, to exclude the serious mimics – above all cauda equina syndrome.
• Most cases settle within 6–12 weeks with activity and simple measures.
| Points towards radicular pain (sciatica) | Points towards non-specific low back pain |
|---|---|
| Leg pain worse than back pain, radiating below the knee | Pain centred on the back or buttock, not extending below the knee |
| Neuropathic quality (burning, shooting, electric); dermatomal numbness or tingling | Dull, aching, "mechanical" pain with no clear dermatomal sensory change |
| Positive straight leg raise or other nerve-tension sign | • Negative tension signs • Pain reproduced by back movement or palpation |
| May have myotomal weakness or a depressed reflex | Power, sensation and reflexes intact |
Source: NICE NG59
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.