Sciatica is a condition characterized by pain, numbness, and/or weakness that radiates along the sciatic nerve, which runs from the lower back down the back of each leg. Meralgia paresthetica is characterized by numbness, tingling, and/or burning pain in the outer thigh due to compression of the lateral femoral cutaneous nerve.
Sciatica
The term sciatic refers to a nerve formed by the nerve roots of the segments L4, L5, S1, S2, and S3 of the lumbosacral spine.
After entering through the pelvis, the nerve leaves the basin, passes between the gluteal muscles near the hip (joint between the head of the femur and the pelvis), and runs through the back of the thigh. The lower part of the thigh is divided into two nerves, the tibial and the common peroneal nerve.
Sciatica, or sciatica, is pain along the course of the sciatic nerve, generally resulting from nerve root involvement in the spine. It may also be due to compression or inflammation of the nerve itself.
Meralgia paresthetica
It causes a “burning” or “burning” pain on the lateral side of the thigh and causes a “numbness” sensation at the site, similar to dental anesthesia.
This pathology affects patients mainly between 30 and 60 years of age.
Meralgia paresthetica symptoms result from the compression of the lateral cutaneous nerve of the thigh and the decrease in its function. The nerve has sensory functions, i.e., responsible for sensitivity only. There is no motor impairment from the compression of this nerve. Thus, movement and strength are not affected by this disease.
What are the causes of sciatic pain?
The most common cause of sciatica is root injury caused by a herniated lumbar disc (herniated disc), but there are several other causes of sciatica:
- Congenital: meningeal cyst, perineural cyst, and joined nerve roots
- Acquired: spinal canal stenosis, spondylosis (spinal arthrosis), spondylolisthesis (spinal slipping), facet cyst, synovial cyst, heterotopic ossification around the hip, intra-muscular injection injuries around the hip, nerve injury after hip surgery, etc.
- Infectious: discitis (infection of the intervertebral disc), herpes zoster.
- Neoplastic: spinal tumors (multiple myeloma and metastases), bone or soft tissue tumors along the course of the sciatic nerve (intra-abdominal or pelvic neoplasia), thigh tumors, calf tumors, etc.
- Inflammatory: trochanteric bursitis and myositis of the bicep-femoral muscle.
- Vascular: sciatica may be mimicated by intermittent claudication.
- Reported pain of non-spinal origin: kidney stone, kidney infection, gallbladder stone, appendicitis, endometriosis, inguinal hernia, duodenal ulcer, etc.
- Piriformis Syndrome: compression of the sciatic nerve by the piriformis muscle. It produces pain in the sciatic distribution and weakness in moving the hip. This is a reasonably common cause and must be ruled out before performing herniated disc surgery!
- Others: femoral neuropathy, sacral plexus injury, diabetic neuropathy (diabetic amyotrophy), etc.
| Sciatica symptoms | Meralgia paresthetica symptoms |
|---|---|
| Pain in the back of the leg and buttock; Low back pain; Leg aches in the form of shock, burning; Usually on only one of the lower limbs; In the most severe cases, there may be a decrease in strength in the lower limb; Pain usually improves when lying down; Pain worsens while sitting or standing; It may worsen when you sneeze or cough. | Tingling or numbness on the side of the thigh; Pain or burning sensation from the hip to the knee; Decreased sensitivity to touch on the side of the thigh. Feeling of tightness or constriction in the anterior thigh. Muscle weakness in the anterior thigh. |
Treatment – rehabilitation and pain management
- Analgesic and anti-inflammatory medications;
- Physiotherapy;
- Ice or local heat;
- Relative rest for short periods;
- Interventional pain procedures such as corticosteroid injections, guided by radioscopy or tomography.
Sciatica Prevention
- Regular physical exercises;
- Avoid being overweight;
- Stretching;
- Muscle strengthening with guidance respecting your limits;
- Ergonomics at work or at home, such as suitable chairs and mattresses;
- Avoid improperly carrying weights.
MD. Physiatrist at University of São Paulo