Sciatica With no other focal neurology

-
Patient presents with lower back pain
Associated burning pain going down the back of leg
Side:

Denies numbness of the leg
Denies any weakness

No trouble toileting and no numbness around the perianal region

 On Examination:

Palpation of the lower back in the midline does not elicit any tenderness

Straight Leg Raise: Pain on lifting the affected leg
Unaffected leg did not cause any pain

Slump Test - Positive

Brief neurological examination of the lower limbs:
- Normal power both sides
- Normal gross sensation
- Normal knee and ankle reflex


Imp:  Sciatica
? Lumbar Disc prolapse

Management:

Explained the diagnosis to the patient and that usually improves in 6-12 weeks
Discussed possible investigations:
- Xray not advised
- MRI-  Will usually determine the cause of pain but private fee involved

Suggested seeing a physio for further assessment and exercise program

Exercise and stretching particularly swimming

Weight control

Return immediately here or to ED if:
- severe weakness and numbness in the legs
- lack of control of the bladder or bowels.





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