Unusual syndromes may mimic sciatica, say experts

Pune: A common cause of pain can be sometime linked to an uncommon source.
Forty-five-year-old Rahul, an IT professional, had pain in his lower back for two years. The pain was so intense that it would radiate till his left foot, leaving him with a tingling sensation and numbness in the entire leg.

After a battery of tests, he was diagnosed with sciatica due to slipped disc. Sciatica refers to symptoms such as pain, tingling, numbness or weakness that radiate along the sciatic nerve that stretches from lumbar spine (lower back) down to one’s feet.

The most common cause of sciatica is a slipped or herniated disc in the lumbar spine. However, in Rahul’s case, the cause was different.

He was diagnosed with piriformis syndrome — an uncommon neuro-muscular disorder that is caused when the piriformis muscle (muscle in the lower limb) compresses the sciatic nerve.

Experts said there were quite a few uncommon conditions where the symptoms of slipped disc or sciatica were mimicked. “As per research, almost 80% magnetic resonance imaging (MRI) scans of spine of general adult population show disc bulges at different level of the spine and a majority of these people are absolutely pain free. It is important to know that all back and leg pains are not because of slipped disc,” orthopaedic surgeon Kiran Shete said.

To diagnose the source of such pain, it is very important to rule out other possibilities that may present with the similar symptoms like slipped disc and sciatica, he added.

Interestingly, piriformis syndrome may not get picked up on x-ray or even high-end MRI imaging. “In the initial stages, piriformis can be treated by manual therapy, but as the condition progresses, injection is given in the piriformis muscle to reduce the spasm and compression of the sciatic nerve. Usually, these patients are completely pain free without any disability,” Shete said. Similarly, pain due to inflammation of sacroiliac joint — medically termed as sacroiliitis — is also like sciatica (pain caused by a spinal disc herniation) but has a different cause. The sacroiliac joint describes the area where the spine meets the pelvis.

“Just like pain in sciatica, patients who are suffering from sacroiliitis complain of pain in their lower back region, mainly in the buttocks, and the pain may also travel down the legs,” spine surgeon Rahul Choudhary said.

Pain management expert Poonam Patel said, “In cases of sacroiliitis where the symptoms are mild, patients can get cured with medications and manual therapy. However, in severe conditions, injection is given for long-term cure.”

Other conditions that mimic sciatica include meralgia paresthetica, which is characterized by tingling, numbness and burning pain in your outer thigh, and clunalgia, which occurs when Superior Cluneal Nerve gets compressed in its osseo-fibrous tunnel. FROM AROUND THE WEB

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