Sciatica refers to pain that is characterized by radiating pain from lower back and buttock region along the path of the sciatic nerve coursing through buttock/hips, down the leg up to the foot region. It is often characterized with other symptoms such as numbness, tingling and motor strength weakness. The most common condition that causes sciatica is a bulging disc in the lumbar region, also sometimes referred to as herniated disc that pinches the nerve resulting in swelling and inflammation of the nerve.
Evaluation: A detailed pain history with onset, provocative maneuvers/factors, quality, radiation, site, other associated symptoms, and time course is the most important thing for an initial evaluation. Pertinent family history such as rheumatological disease and other past medical history could also help narrow down the diagnosis.
Physical examination such as a thorough focused lumbar exam, gait assessment, pelvis exam and neurological exam can help narrow down on the differential diagnosis.
Radiographic evaluation such as plain x-rays are generally considered first line. Advanced imaging such MRIs can help substantiate diagnostic secondary to a disc herniation, pinched nerve due to arthritis, or vertebral column instability commonly known as spondylolisthesis, etc.
