While the pain usually stops at the knee, it can extend into the lateral or posterior leg. Sacroiliitis can present as pain localized to the low back or buttock, but it also can refer pain laterally along the waistline, into the groin and hip and down the posterior or lateral thigh. There are a few other conditions that can mimic sciatica yet occur outside the lumbosacral spine. The patient may have pain with sitting due to weight bearing on the buttock, a positive piriformis test, or pain with palpation at the lateral margin of the sacrum. It may occur due to muscle hypertrophy, fibrosis following trauma or anatomical anomalies involving the nerve roots. Piriformis syndrome is a rare condition that causes pain in the distribution of the sciatic nerve. More often, the patient will experience worsening pain with extension and facet loading, as opposed to a patient with discogenic pain who will frequently complain of increased pain with lumbar flexion. In the case of an L5 radiculopathy, there also may be weakness in the ankle dorsiflexors, inverters and everters, hip abductors or extensor hallucis longus, as well as a decreased or absent patellar reflex.Īlthough facet arthropathy generally does not extend past the knee, it can refer pain down the posterior thigh and even into the leg. In the presence of an S1 radiculopathy, motor testing may discover weakness in the ankle plantar flexors and hip extensors, along with a decreased or absent Achilles reflex. Cervical flexion may also reproduce the pain, as it causes traction of the dura, lumbosacral nerve roots and sciatic nerve.

In a seated position, there may be a positive Bechterew or slump test. When sciatica originates from these roots, there may be key findings indicative of radiculopathy on a physical exam.įor an L5 or S1 radiculopathy, there may be a positive straight leg raise or crossed straight leg raise in a supine position. A true sciatica describes irritation of the six nerve roots that comprise the sciatic nerve.

Sciatica is a descriptive term that refers to radiation of pain from the lower back down the back of the thigh and leg in the distribution of the sciatic nerve. By Rebecca Shoemaker, MD, Hampton Roads Orthopaedics & Sports Medicine

Examination of sciatica