Damage to the sciatic nerve treatment. Neuropathy of the sciatic nerve symptoms

Back diseases always bring discomfort to a person, violate his usual daily routine. This is due to the fact that the back is involved in almost all movements of the body, it is a support, protection for internal organs. There are many types of back problems. One of them is sciatica.

Why does the sciatic nerve bother

There are several diseases accompanied by pathology of the sciatic nerve (n. ischiadicus). One of the most common is sciatica. This disease is caused by inflammation of the sciatic nerve due to degenerative changes in the spine (osteochondrosis, spondylolisthesis, osteoarthritis of the facet joints, herniated disc). Sometimes the term "sciatica" is identified with "sciatica", but this is not entirely correct. It would be more accurate to say that sciatica is vertebrogenic sciatica.

In addition to degenerative diseases, the cause of pain along the course of n. ischiadicus can be:

1. Sciatica associated with tunnel neuropathies, such as piriformis syndrome. This pathology is associated with infringement of the nervous structures n. ischiadicus in the subpiriform foramen against the background of spasm of the piriformis muscle. In addition, compression can be in the pelvic cavity, above the gluteal fold, and also below the piriform opening at the level of the thigh.
2. Ischialgia associated with compression of nerve structures by a hematoma, post-injection abscesses, more often in the region of the gluteus maximus muscle (n. ischiadicus comes out from under its lower edge).
3. Direct injury to the sciatic nerve as a result of an incorrect injection, an accident with fractures of the pelvis and hip bones.
4. Neuropathy associated with metabolic disorders (diabetes mellitus, alcoholism, etc.)
5. Viral and bacterial infections.
6. Tumors.
7. Ischialgia resulting from neuropathy under the influence of certain toxic substances.

Most often, people of the older age group suffer from sciatica and much less often at the age of 20-25 years. Also, sciatica can occur in the last trimester of pregnancy due to the fact that the load on the spine increases significantly at this time.

There can be quite a lot of reasons for the occurrence, both obvious and imperceptible to the naked eye. Among them, the most common and most common are the following factors:

• too sudden movements;
• weight lifting;
• intense physical activity, especially against the background of the usual sedentary lifestyle;
• stressful conditions and other strong emotional upheavals;
• hypothermia.

In addition to these factors, there are a number of diseases that can contribute to sciatica. Among them are:

• spondylolisthesis;
• tumors and neoplasms in the area of ​​the spine and spinal canal;
• herniated disc;
• vertebral osteophytes.

Among the signs and manifestations of sciatica, it is worth noting several main ones:

• pain along the way n. ischiadicus;
• disorder of the motor function of the muscles innervated by n. ischiadicus, paresis, less often paralysis of this muscle;
• a disorder of sensitivity in areas receiving sensitive fibers of a given nerve;
• decrease and loss of reflexes - Achilles, knee, plantar;
• a decrease in the quality of life, a violation of sleep and normal human activity, an increase in the level of anxiety.

Most often, the pain of those suffering from inflammation, pinching of the sciatic nerve is very intense. And usually they are chronic. Literally every movement can cause unbearable pain, which always negatively affects a person’s daily life. The place of its localization: the area of ​​the buttocks, thigh (back surface), shin. Sometimes the whole leg hurts. It depends on which nerve roots are involved in the pathological process (see figure below).

In addition to painful sensations, a person may lose sensitivity of the skin on part of the leg, there are problems with movement, a change in the shade of the skin and their dryness, increased sweating, and disorders associated with reflexes.

Diagnosis of pain

First of all, to make a diagnosis, the doctor will talk in detail with you about the disturbing symptoms. Then he will examine the painful areas of the skin and decide on further examination. To diagnose sciatica and prescribe a specific treatment regimen, a specialist can use the following research methods:

• CT scan;
• radiography;
• electroneuromyography.

Blood tests and other laboratory tests may also be required to exclude the presence of diseases similar in symptoms.

There are many ways to get rid of sciatica. You can cope with this disease with the help of medicines, special physical activity and changing a number of habits to more useful ones, as well as using alternative medicine methods.

Traditional

The main goal of the doctor after identifying the cause of pain in the back and sciatic nerve is to reduce the intensity of pain experienced by the patient. For this, anesthetic and anti-inflammatory drugs are used, such as Diclofenac, Meloxicam, Ibuprofen, Ketoprofen, Voltaren, Ketorolac and other NSAIDs. Blockades with local anesthetics are also used. In addition to these funds, the doctor may prescribe vitamin complexes (Milgamma, Neuromultivit), mineral, vascular preparations (Actovegin, Berlition, Trental, Pentoxifylline) or immunostimulants. If the pain was provoked by another disease, then all forces are rushed to eliminate it. For this, hormones, various enzymes, antibiotics and other means can be used.

Also, when the sciatic nerve is concerned, the following procedures are very often prescribed:

• physiotherapy;
• massage;
• various physiotherapeutic procedures (magnetotherapy, laser therapy, UVI, UHF, electrophoresis).

Folk and non-traditional methods of treatment

The intensity of pain along the sciatic nerve can be significantly reduced with the help of alternative medicine methods. Well helps acupuncture, manual therapy, osteopathy. Also widely known is the Tibetan method of treatment, which is still popular today.

Folk remedies are applicable for pain in the sciatic nerve. These are rubbing, ointments, rubbing and compresses, which are designed to reduce inflammation and reduce pain. Basically, they have a warming and distracting effect. More often than others, black radish, natural honey, homemade agave, thyme, and horsetail are used in the preparation of ointments, decoctions and compresses.

Remember that any treatment should be used only after consulting a doctor. After all, each of them has contraindications. And, perhaps, instead of a healing effect, it will bring you even more serious health problems. It is also not recommended to self-medicate with this disease in order to prevent a more severe course and chronicity.

As you can see, there are many ways to treat when the sciatic nerve hurts, both medical and folk. It should be noted that this is a fairly serious disease. Therefore, at the first painful sensations, it is important to immediately seek help from a qualified specialist who, after conducting the necessary studies and analyzes, will make the correct diagnosis and prescribe a treatment regimen that is right for you.

Sources:

1. Neuropathy of the sciatic nerve. Piriformis Syndrome. M.V. Putilin. Journal Attending Physician, 02/06.
2. Treatment of dorsopathies in the practice of a neurologist. Skorokhodov A.P. Polyanskaya O.V. Russian Medical Journal, No. 16, 2015.
3. Treatment of back pain: a modern view on the use of NSAIDs and B vitamins. Strokov I.A. and others. Russian Medical Journal, No. 2, 2015.

Among the many problems associated with the lower limbs, one should single out the situation when the legs go numb. A general practitioner hears such complaints almost daily, not to mention narrower specialists. And this does not bring anything to patients, except for inconvenience and anxiety for the state of their health. To get rid of such sensations, you should first find out their cause and do everything exactly as the doctor recommends.

Causes

The most common numbness is below the knees. This is due to the fact that the legs and feet, firstly, are subject to a significant load, carrying the weight of the whole body, and secondly, they are as far as possible from the central organs of the vascular and nervous systems. Such conditions create prerequisites for the development of conditions that are characterized not only by local disturbances, but also by damage at a distance. These should include:

• Polyneuropathy.
• Vascular diseases.
• Diseases of the spine.
• tunnel syndromes.
• Pathology of the spinal cord and brain.
• Traumatic injuries.
• Tumors.
• Frostbite.

Thus, the problem may lie not only in the peripheral parts of the limbs, but also much higher - in the spine and even the head. Finding out why the legs go numb from the hip to the foot can be done through a thorough differential diagnosis, taking into account all conditions with a similar clinical picture.

The causes of leg numbness are quite diverse, the same symptom can indicate a completely different pathology.

Symptoms

To determine the symptoms of the disease, the doctor conducts a clinical examination. It includes subjective information received from the patient (complaints), as well as objective data revealed during the examination. All symptoms are subjected to maximum detail and subsequent analysis in order to form a holistic view of the disease.

Unpleasant symptoms can be felt in various parts of the limb: thigh, lower leg or foot. Their localization will often tell a lot about the location of the main pathological focus. However, leg numbness is unlikely to be the only sign of pathology - most often there are other manifestations, sometimes more significant.

Polyneuropathy

A common cause of leg numbness below the knee is polyneuropathy. In most cases, it occurs due to metabolic disorders in the body (diabetes mellitus, thyroid disease, kidney failure, various intoxications). The disorders are not limited to numbness, but include the following symptoms:

1. Moderate or intense pain in the legs and feet.
2. Crawling sensation, burning sensation.
3. Decreased surface sensitivity.
4. Changing reflexes.

In addition to the lower extremities, nerves in other parts of the body can be affected, since the process is multiple. Polyneuropathy necessarily occurs against the background of the underlying disease, which has its own characteristic features.

If the legs are numb below the knees, then first of all it is necessary to consider the issue of multiple nerve damage - polyneuropathy.

Vascular diseases

Numbness in the legs from the hip to the foot can be the result of vascular problems. To develop sensitivity disorders, a long course of the disease is required, so acute conditions should not be borne in mind. As a rule, such a symptom is considered as a sign of endarteritis, atherosclerosis or varicose veins of the lower extremities. Along with it, the following complaints can be noted:

1. Feeling of tiredness in the legs in the evening.
2. Pain in the calf muscles when walking is a symptom of "intermittent" lameness.
3. Paleness or cyanosis of the skin, dilated saphenous veins.
4. Reduced pulsation in various parts of the main arteries: on the foot and above - under the knee, in the thigh area.
5. Trophic disorders: hair loss, ulceration.

In most cases, there is a bilateral lesion of the arteries or veins. If you do not pay attention to the signs of the disease in time, especially with endarteritis and atherosclerosis, you will have to expect a significant increase in ischemia, which in the future can cause gangrene.

When symptoms of vascular pathology of the lower extremities appear, in order to avoid complications, you should consult a doctor in time.

Diseases of the spine

The cause of numbness of the lower extremities often lies in diseases of the lumbar spine - osteochondrosis or disc herniation. In this case, compression of the spinal roots, giving rise to the sciatic nerve, occurs, which is manifested by the following symptoms:

1. Pain in the lower back, radiating to the leg - the buttock, the back of the thigh, lower leg and foot.
2. Other disturbances of sensitivity.
3. Feeling of weakness on the affected side.
4. Limited mobility of the lumbar.

Compression of the root often occurs on one side, but damage to both nerves is not excluded. On examination, tension in the muscles of the back and soreness of the paravertebral points are revealed. Therefore, when the leg becomes numb, it is imperative to pay attention to the condition of the spine.

Tunnel Syndromes

If leg numbness occurs in a particular area, then we can assume compression of the corresponding nerve in the canal formed by bones, tendons and muscles. This is observed at various levels, starting from the inguinal fold and is provoked by injuries, hematomas, and tumors.

When the right leg goes numb along the outer surface of the thigh, above its middle, Roth's disease can be assumed. In another way, this is neuropathy of the external cutaneous nerve, which is located very superficially and can be squeezed by a belt or objects located in pockets. Only local sensory disturbances are characteristic. Numbness from the inside of the leg indicates damage to the femoral nerve. At the same time, movement disorders are also observed:

1. Decreased knee jerk.
2. Weakness and hypotrophy of the quadriceps and iliopsoas muscles.
3. Violation of flexion of the hip and knee.

And if, for example, the left leg goes numb outside the lower leg and along the back of the foot, then you need to think about compression of the peroneal nerve. Patients complain of pain in the legs below the knee, crawling "goosebumps". The extension of the foot and fingers is disturbed, because of which walking suffers.

Any numbness in the lower extremities should be considered as a sign of pathology, the nature of which is to be determined by the doctor.

Treatment

After it becomes known why the patient's legs go numb, treatment should be started immediately. First of all, it is necessary to eliminate the cause of such a condition, whether it is nerve compression, vascular occlusion, or a violation of metabolic processes in the body. Only after the elimination of the main pathological process can we talk about the restoration of sensitivity in certain parts of the lower limb.

Medical therapy

To treat the disease that caused numbness in the legs, in most cases, they begin with medication. The doctor selects the optimal drugs that are indicated for the identified pathology, and the patient only needs to follow his recommendations. Depending on the clinical situation, the following medications can be used:

• Anti-inflammatory (Ortofen, Larfix).
• Muscle relaxants (Mydocalm).
• Vitamins (Milgamma).
• Antiplatelet agents (Aspecard).
• Venotonics (Detralex).
• Antioxidants (Cytoflavin, Berlition).
• Vascular (Actovegin, Latren).

Treatment will be more effective if it is carried out in steps - first, injectable forms of drugs are used, and then tablets.

Physiotherapy

Physiotherapy methods help to improve nerve conduction and blood circulation. Such treatment includes local and general procedures that take place under the supervision of a specialist. With numbness of the limbs above or below the knees, the following methods can be shown:

• Electrophoresis.
• Magnetotherapy.
• Wave treatment.
• Barotherapy.
• Reflexology.
• Spa treatment.

The physiotherapist will create an optimal program consisting of the most effective procedures. In combination with other methods, this will be a good impetus to recovery.

Physiotherapy

When the left leg becomes numb after an injury or similar symptoms appear due to osteochondrosis, certain therapeutic exercises are required that will restore not only the motor function of the limb, but also help normalize sensitivity. You need to do gymnastics regularly, starting in a hospital and under the supervision of a doctor, and continuing at home. But such exercises are justified only after the elimination of the pain syndrome.

Operation

In some cases, adequate treatment is possible only by surgery. This happens with serious injuries, severe vascular pathology, tumors, intervertebral hernias. The main goal of surgical intervention is to eliminate pathological formations that cause compression of nerve fibers or impaired blood flow through the vessels. Recently, endoscopic and microsurgical techniques have been used, which are less traumatic compared to open surgeries and do not require long-term recovery.

With numbness of the lower extremities, you should first of all find out what causes such a symptom. The correct diagnosis allows you to effectively treat the disease, which gives hope for a speedy recovery.

Modern methods of treatment of lumboischialgia

Lumbosciatica (classification according to ICD 10 54.4.) - back pain radiating to one or both legs.

It extends down the buttock and also down the back of the leg to the toes.

In this disorder, the roots of the spinal cord - the sciatic nerve - are involved in the process.

The pain can be different, but often it is a burning, aching, intensifying pain. It spreads along the sciatic nerve. The patient has a feeling of heat or chilliness.

Causes of pathology

The pathogenesis of the disorder is as follows: pain occurs when the nerves are irritated due to compression, damage, inflammation. Pain may increase when the muscle in the affected area is tense, its nutrition is disturbed, nodes and tubercles appear.

Causes of lumboischialgia:

• osteocondritis of the spine;
• arthrosis of the spinal disc;
• osteoporosis of the spine and pelvic bones;
• scoliosis, spondylitis;
• congenital lesions of the vertebrae;
• tumors, abscesses in the lumbar region;
• tumors of internal organs;
• diseases of large vessels, causing a violation of blood flow in the lower back;
• damage to muscles, hip joint;
• lower back injuries;
• complications after surgery;
• unsuccessful injections into the epidural region;
• rheumatism;
• severe infections with damage to the nerve trunks;
• lumboischialgia without a specific cause.

Factors causing the appearance of the syndrome:

• degenerative age-related changes in the spine,
• obesity;
• pregnancy;
• frequent stress;
• depression;
• posture problems;
• hard work;
• hypothermia.

Disease classification

Often there are such forms of the disease:

This form of lesion can be distinguished from others by the following features:

• severe pain in the lower back, lasting for a long time - up to several years;
• a clear connection of pain in the lower back and joints of the legs;
• damage to the large joints of one or both legs;

Vegetative-vascular left-sided or right-sided lesion is characterized by a combination of unpleasant sensations: burning or aching pain, which increases with a change in the position of the leg; foot numbness, heat or cold in the affected part.

Outwardly, the violation can be recognized as a discoloration and dryness of the skin, swelling in the ankle area. With prolonged low back pain, there is blanching of the skin of the toes and a decrease in pulsation on the back of the foot.

Often, signs of all types of lumboischialgia occur simultaneously - a mixed form of the disease.

Also, the syndrome can be:

• acute - primary emerging syndrome;
• chronic - acute periods alternate with remissions.

Due to appearance:

1. Vertebrogenic (associated with diseases of the spine): discogenic, spondylogenic.
2. Non-vertebrogenic: angiopathic, myofascial; with damage to the organs of the peritoneum, due to pathologies of the femoral joint.

More about vertebrogenic lumboischialgia

According to the degree of spread of pain:

• unilateral (right-sided and left-sided lumboischialgia) - gives to one limb;
• bilateral - gives to both legs.

Symptoms and signs of lumboischialgia

Symptoms include:

• stiffness of movements in the lower back;
• increased pain when changing body position;
• "Return" of pain along the nerve during movements;
• fixing the back in a position slightly bent forward;
• due to a violation of blood supply, a change in the color and temperature of the skin of the legs;
• pain that occurs when stepping on the foot.

The disease is of a benign nature, and therefore it is treated quite successfully.

With such symptoms, you should immediately contact a medical facility: back pain after injury, fever, swelling or redness of the spine, decreased sensitivity of the pelvic organs and legs, uncontrolled urination or defecation.

Diagnostic methods

Methods of examination of the patient with suspicion of such a lesion:

• x-ray of the spine;
• MRI or CT scan of the spine, hip joint, blood vessels;
• densitometry;
• Ultrasound, MRI of the abdominal space;
• blood tests for markers of infections and immune disorders.

How to treat the disease

For the treatment of lower back pain, it is necessary to wear corsets, sleep on special mattresses.

How exactly to treat lumboischialgia is decided only by the doctor. For the most part, the pathology is successfully treatable.

Treatment is aimed at neutralizing the provoking disease and eliminating pain.

Medical treatment

In the acute period, the patient needs rest (up to 2 weeks) and the chicken takes certain drugs.

In the treatment of the disease, the following drugs are prescribed:

1. Painkillers - injections or tablets of non-steroidal anti-inflammatory drugs (brufen, movalis), non-narcotic analgesics (lyrica, katadolon).
2. Muscle relaxants - to neutralize muscle spasm (sirdalud, mydocalm).
3. Diuretic - against swelling of the nerve trunks (lasix).
4. Novocaine blockade in the spine, with unbearable pain - blockade with glucocorticosteroids (diprospan, hydrocortisone).
5. Sedative drugs (phenozipam, Relanium).
6. B vitamins - to activate nerve conduction and muscle recovery (milgamma, neuromultivit).
7. Blood flow activators (trental, actovegin).
8. Local painkillers - ointments, creams with non-steroidal components (diklak, fastum-gel).

Physiotherapy

Effective treatment procedures:

• acupuncture;
• massage;
• electrophoresis with drugs;
• microcurrent treatment;
• magnetotherapy;
• paraffin therapy;

All procedures are selected by the doctor, taking into account contraindications and the nature of the underlying violation. With osteochondrosis, manual therapy and traction of the spine are used.

Physiotherapy

After removing restrictions on movement and eliminating pain, a course of exercise therapy is prescribed:

• Crick;
• exercises to improve the mobility of the spine and hip joints;
• stretching the spine on an anatomical couch;
• classes on special shells;
• yoga.

homeopathic treatment

Simultaneously with standard treatment, it is possible to use homeopathic remedies. They have a positive effect on the entire body, activate the processes of self-regulation and self-healing.

The most effective drugs are "Traumel-S", "Target-T". They consist of useful plant complexes, minerals, chondroprotectors that relieve inflammation, improve blood circulation, metabolic processes, and restore cartilage and bones.

Folk methods

Treatment of lumboischialgia at home:

• rubbing the sore spot with badger fat;
• wearing belts made of dog hair;
• compresses from the infusion of birch buds;
• baths with a decoction of pine needles;
• applying warm patches;
• rubbing the composition of vegetable oil and ammonia (2: 1);
• lotion of grated horseradish, black radish.

Surgery

With frequent exacerbations, it is possible to carry out surgical treatment of the disease.

Often it is necessary for a herniated disc, compression of the nerve roots that cause partial paralysis, cauda equina syndrome, the presence of a tumor, etc.

After the intervention, the patient needs a long recovery, consisting of massage, reflexology, exercise therapy, taking vitamins.

Psychotherapy

An important nuance in the treatment is the use of psychotherapy, which can influence the patient's behavior in a difficult situation.

The doctor will explain the procedure for changing a person's behavior, helps to get rid of bad habits, conducts trainings to abandon negative thoughts, to eliminate depression.

The patient needs to develop useful skills and abilities for relaxation, muscle relaxation, removal from pain.

After receiving the prescriptions, it is important to learn how to eliminate the attack yourself: have the necessary funds on hand, take a contrast shower, apply dry heat to the affected area.

During the period of remission, you need to lead a mobile lifestyle, wear bandages, sleep on a special mattress.

How to prevent back pain

Prevention measures:

• do not stay in an uncomfortable position for a long time;
• do not wear shoes with heels;
• sit on comfortable chairs;
• do relaxing exercises at work;
• do not carry heavy;
• do not overcool;
• stop smoking;
• normalize weight;
• time to treat lesions of the joints, spine, blood vessels.

conclusions

Lower back pain is a serious symptom that requires attention and an immediate response. The treatment of the disorder is quite lengthy and not always effective, so timely warning will help you protect yourself from unpleasant surprises in the future.

Constant care and attention to the needs of the body will make it possible to live life without pain and restrictions.

Lumbosciatica is a non-life-threatening disease that can be treated. Subject to all the doctor's prescriptions and attentive attitude to health, a long remission or an absolute cessation of pain is possible.

Neuropathy of the sciatic nerve is manifested by weakness of the leg flexors, extensors and flexors of the foot, a decrease in sensitivity in the lower part of the lower leg and but the outer edge of the moan, a decrease or loss of the Achilles reflex. Neuropathy of the sciatic nerve can be the result of trauma, unsuccessful injection, prolonged lying on the back or side (including during long-term operations), spasm of the piriformis muscle. The sciatic nerve can be compressed by a tumor or hematoma in the pelvis, an aneurysm of the iliac artery. With positional compression of the nerve, spontaneous recovery occurs within a few months. In piriformis syndrome, injection into the muscle with the help of a local anesthetic and a corticosteroid is effective.

Sciatic nerve anatomy

The most powerful nerve, formed from the anterior branches of L4–S3. The nerve leaves the pelvic cavity through the piriformis opening. The location of the nerve between the piriformis muscle and the tight sacrospinous ligament makes it easily vulnerable to compression. After leaving the subpiriform opening, the nerve high on the thigh gives muscle branches to the leg flexor muscles (biceps femoris, m. biceps femoris; adductor magnus, m. adductor magnus; semimembranous muscle, m. semimembranosus; semitendinosus muscle, m. semitendinosus). At the level of the popliteal fossa (often higher), the sciatic nerve divides into two large branches - the tibial and peroneal nerves. Neuropathy of the sciatic nerve symptoms

Neuropathy of the sciatic nerve symptoms

Symptoms of damage to the sciatic nerve - a combined dysfunction of the tibial and peroneal nerves, as well as muscle branches to the flexors of the leg. Damage to the sciatic nerve is accompanied by severe pain, vasomotor, secretory, trophic disorders, and partial damage - causalgic syndrome (CRPS). Palpation reveals soreness along the sciatic nerve, it is possible to detect a positive symptom of Lasegue. Damage to the sciatic nerve can be caused by injury, fracture of the pelvic bones, inflammatory processes in the pelvic floor and buttocks.

A common variant of sciatic nerve neuropathy is compression of a spasmodic piriformis muscle (piriformis syndrome).

Clinically defined:

1) burning pains and paresthesias in the lower leg and foot;

2) possible weakness in the muscles of the lower leg and foot;

3) violation of sensitivity in the zone of innervation of the nerve;

4) palpation soreness of the places of attachment of the piriformis muscle (the anterior part of the greater trochanter and the lower part of the sacroiliac joint);

5) provocation of pain during passive adduction and internal rotation of the thigh;

6) pain on palpation of the buttock at the exit point of the nerve from under the piriformis muscle;

7) therapeutic effect of novocaine blockade of the piriformis muscle.

A consultation on treatment with traditional oriental medicine (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug methods of treatment) is held at the address: St. Petersburg, st. Lomonosov 14, K.1 (7-10 minutes walk from the metro station "Vladimirskaya / Dostoevskaya"), with 9.00 to 21.00, without lunch and days off.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of "Western" and "Eastern" approaches. Significantly reduce the duration of treatment, reduces the likelihood of recurrence of the disease. Since the "eastern" approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the "cleansing" of blood, lymph, blood vessels, digestive tract, thoughts, etc. - often this is even a necessary condition.

The consultation is free of charge and does not obligate you to anything. On her highly desirable all the data of your laboratory and instrumental research methods over the last 3-5 years. After spending only 30-40 minutes of your time, you will learn about alternative methods of treatment, learn how to improve the effectiveness of already prescribed therapy and, most importantly, about how you can fight the disease yourself. You may be surprised - how everything will be logically built, and understanding the essence and causes - the first step to successful problem solving!

Among the various iatrogenic mononeuritis and neuropathies (from the use of radiation energy, fixing bandages or as a result of incorrect position of the limb during surgery, etc.), post-injection ones are most common.

The damaging effect is exerted by toxic, allergic and mechanical factors - the impact of the needle. Damage to the nerve trunk, as already mentioned, may be due to its direct injury with an injection needle, or through the compression-ischemic effect of surrounding tissues containing post-injection: hematoma, bruising, infiltration or abscess.

Similar lesions have been described with the introduction of salvarsan, mercury, camphor, biyoquinol, quinine, antibiotics, magnesium sulfate, cocarboxylase, vitamin K and other drugs (Olesov N.I., 1962; Kipervas I.P., 1971; Trubacheva L.P. , 1973; Ismagilov M.F., 1975; Skudarnova Z.A., Nikolaevsky V.V., 1976; Macheret E.L. et al., 1979; Krasnikova E.Ya., 1986; Oppenheim H., 1908, and etc.).

Among post-injection neuritis, according to M. Stor (1980), lesions of the sciatic nerve occur in 28% of patients, radicular lumbosacral - in 13%, brachial plexus - in 9%, median nerve - in 9% of patients.

Consider post-injection neuropathy using the example of a lesion of the sciatic nerve. Sciatic nerve lesions occur when injections are made not in the upper outer quadrant of the buttock, but closer to the middle and to the bottom, or with a correctly chosen injection site, but with an oblique rather than perpendicular direction of the needle.

Clinical manifestations can be acute - immediately after injection or develop gradually over several weeks. Motor disturbances predominate over sensory disturbances, pain is rarely disturbed. An equinovarus position of the foot develops, which hangs down, its abduction and extension of the fingers are impossible (the function of the peroneal nerve drops out). The absence of the Achilles reflex while maintaining incomplete active adduction and flexion in the ankle joint indicates damage to the tibial nerve. With deep (total) lesions of the sciatic nerve, movements in the foot are completely absent (a clinical picture of the type of "paralyzing sciatica").

A significant difference between paretic manifestations due to damage to the sciatic nerve from a similar paresis of radicular genesis is the vegetative-vascular and trophic components. The foot becomes edematous, dark cyanotic, skin temperature changes. Often the patient feels hot or cold in the foot, it is difficult for him to step on the foot, due to increased pain in it (“as if on pebbles”) with the frequent absence of hypalgesia. Trophic disturbances are expressed.

Along with atrophy of the muscles of the lower leg and foot, its shape changes: the arch deepens, in children the foot lags behind in growth, retraction of the Achilles tendon quickly forms, which can lead to stable fixation of the foot in a vicious position. In such cases, recovery is delayed for months and years; approximately at 12% of patients it does not come. With mild nerve damage, the recovery period may be limited to 1 to 4 weeks.

With mechanical damage to the nerve, treatment should be phased. The duration of degeneration of the nerve trunks is usually 3-4 weeks or more (depending on the severity and level of damage, on the age of the patient, etc.). Therapeutic measures at this stage are aimed at preventing complications from the joints, tendons, skin, maintaining muscle trophism. They include passive therapeutic exercises and passive local hydrokinesitherapy.

Approximate terms of regeneration of nerve trunks according to G.S. Kokin and R.G. Daminov (1987) the following: lateral triangle of the neck, subclavian and axillary regions - 6 - 12 months, shoulder level - 4 - 9 months; forearm level - 3 - 9 months; thigh level: sciatic nerve - 12 months, femoral nerve - 6 - 12 months; lower leg level: peroneal nerve - 6 - 12 months. At this stage, to prevent rough scarring, electrophoresis of lidase, iodine, ultrasound (with partial nerve damage), pelotherapy (mud, paraffin, ozocerite), electrical stimulation of nerves are advisable; dibazol.

Approximate terms of reinnervation of tissues, organs, restoration of reflex connections are as follows: initial recovery phase - 1 - 2 months; partial recovery phase - 6 - 12 months; a phase close to full recovery, or a phase of full recovery in the lateral triangle of the neck, subclavian and axillary region - 2-5 years, at the level of the shoulder - up to 5 years, at the level of the forearm - 2-3 years. For the level of the thigh, the terms are as follows: sciatic nerve - up to 5 years, femoral nerve - up to 2 years, for the level of the lower leg: peroneal nerve - 2 - 3 years, tibial nerve - 3 - 5 years.

Injury and compression of the nerve trunks, accompanied by a violation of the anatomical integrity, are subject to surgical treatment - neurorhaphy (suturing of the nerve trunks), neurolysis and neuroectomy.

Naturally, the complex treatment of post-injection neuropathy should include drugs that improve the conduction of a nerve impulse along the nerve fiber (anticholinesterase drugs: proserin, neuromidin, axamon), improve nerve trophism (benfotiamines: milgamma, combilipen, benfolipen, etc.), antioxidant drugs (lipoic drugs). acids, mexidol, etc.). With the development of neuropathic pain syndrome, anticonvulsants (carbamazepine, gabapentin, pregabalin), antidepressants with an analgesic effect (amitriptyline, venlafaxine) are used.

But it must be remembered that the combined use of venlafaxine and gabapentin reduces the effectiveness of these drugs in neuropathic pain syndrome. Thus, under conditions of an experimental pain model (compression of the sciatic nerve, local administration of formalin), the use of both venlafaxine and gabapentin led to a significant decrease in the intensity of mechanical hyperesthesia, and the isolated administration of gabapentin was also accompanied by a decrease in allodynia. The simultaneous administration of both drugs led to a significant decrease in the anti-allodynic effect (source: recommendations for physicians "The use of antidepressants for the treatment of patients with chronic pain syndromes" Kamchatnov P.R. N. I. Pirogova, Moscow, 2009, p. 12).

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Sciatic nerve neuropathy is a lesion of the longest nerve in the human body, which runs from the sacral spine along the back of the thigh to the toes.

The outdated name of the disease "sciatica" is familiar to many. For ease of understanding between the doctor and the patient, it is still used today. The disease, if left untreated, threatens with disability, in some cases leads to disability.

Causes

Sciatic nerve neuropathy (ICD-10 code G57.0) is unilateral. The most frequent cases of the disease among people aged 40 to 60 years. Pathology refers to socially significant diseases, since it significantly affects the ability to work. For diagnosis and treatment, they turn to practicing vertebrologists, neurologists.

The most common causes of sciatic nerve neuropathy are:

• Neoplasms that compress the nerve roots.
• Infections (herpes, tuberculosis, scarlet fever, measles, HIV, etc.).
• Diseases of the pelvic organs.
• Prolonged hypothermia.
• Fractures or dislocations of the hip, spine.
• Metabolic disorders (diabetes mellitus, gout, etc.).
• Deep thigh wounds (torn, cut, gunshot), hematomas.
• Pathologies of the spine (hyperlordosis, scoliosis, spondylarthrosis, intervertebral hernia, etc.).
• Intoxication (alcohol, drug poisoning, exposure to chemicals).

Symptoms

Sciatic neuropathy (sciatica) has many manifestations, the main symptom is severe pain. It can be localized in one place or spread along the entire length of the nerve, reaching the heel and fingers. Patients, characterizing the pain, use such comparisons as dagger, burning. Almost always, the pain syndrome is very strong, sometimes the degree of pain is such that a person loses the ability to move independently.

The main symptoms of the disease:

• Palpation causes exacerbation of pain in the back of the thigh, gluteal muscle, lower back.
• In the place of the focus of pain, a change in skin color (redness) is observed.
• The patient feels pain or discomfort along the entire length of the limb.
• In some cases, paralysis occurs (complete, partial) and numbness of the foot, lower leg.
• The body temperature is increased by several degrees and is stably kept above the norm for a long time.
• In the supine position, when the leg is abducted to the side, the patient experiences a sharp, shooting pain.
• There may be difficulty urinating.
• In advanced cases, trophic ulcers appear on the foot, heel or fingers, keratinization of the skin may occur or excessive hair growth can be observed.

Sciatic neuropathy causes the patient to change their gait in order to reduce the intensity of pain. The patient tries to walk with a straight leg.

Diagnostics

With symptoms of neuropathy of the sciatic nerve (in the ICD-10, as mentioned, code G57.0), they turn to a neurologist or vertebrologist. At the first stage, the specialist conducts an external examination and a test for the presence of the patient. The patient is placed on the couch face up, the doctor bends the affected leg at the knee by about 90 degrees and slowly straightens it. Based on the presence and intensity of pain, the size of the extension angle, the doctor draws conclusions about the degree of development of the disease. Next, diagnostic tests are scheduled.

Diagnostic methods:

• X-ray. The study is carried out in the frontal and lateral projection to detect changes in the intervertebral discs.
• The most demonstrative method of diagnosing neuropathy of the sciatic nerve is MRI. The collected data and full visualization of the nerve, spinal cord, vertebrae, discs and surrounding tissues reveal the location of the lesion, the degree of inflammation and the development of the disease.
• radioisotope scanning. The study is necessary to confirm or refute suspicions of oncology. The method is relevant for patients who have taken corticosteroid drugs for a long time, as well as for people with HIV infection.
• Electromyography. This type of study makes it possible to assess the condition of the muscles, identify the localization of the inflammatory process, and assess the degree of nerve damage. During the recovery period, electromyography helps to assess the rate of recovery of nerve fibers.

To obtain a complete picture of sciatic nerve neuropathy and make a verdict, consultation of highly specialized specialists is sometimes required. In such cases, they turn to a rheumatologist, vascular surgeon, dermatologist, etc.

Treatment

When a complete diagnosis has been made and the symptoms of inflammation of the sciatic nerve have been confirmed, the treatment is prescribed in a complex manner to eliminate the manifestations of the pathology and restore the nerve tissues. Therapy includes the use of medications and physiotherapy.

In the stage of exacerbation of the disease, the following groups of drugs are prescribed:

• Intramuscular administration of anti-inflammatory non-steroidal drugs during the first three days from the moment of exacerbation, then the patient is transferred to tableted, powdered agents, and ointments and creams for external use are also prescribed (Nimesulide, Meloxicam, Ketanov, Ketonal, Movalis, etc.).
• Muscle relaxants - relieve muscle spasm, muscle tone, reduce pain (Baclofen, Mydocalm, etc.).
• Antioxidants - normalize nutrition and metabolism in tissues and nerve fibers (vitamins C, E, as well as copper, selenium).
• Metabolites - improve the nutrition of the nerve roots, the nerve trunk, contribute to the restoration of motor activity and sensitivity ("Meldonium", "Inosine", "Karnitsetin", etc.).
• Vasoactive drugs - stimulate blood microcirculation in damaged tissues (nicotinic acid, etc.).
• Vitamins - a complex of B vitamins stimulates intracellular metabolism ("Combilipen", "Milgamma").

In some cases, with severe pain, the patient is given a blockade by injection into the site of pain localization. The procedure is carried out by an experienced specialist in a clinic or hospital. Total anesthesia lasts at least 12 hours and no more than 3 days.

Physiotherapy and other methods

Neuropathy of the right sciatic nerve or the left responds well to physiotherapy procedures designed to consolidate success.

Effective Methods:

• UHF - increases the permeability of the walls of blood vessels, warms up the site of the lesion, promotes the regeneration of damaged tissues.
• Magnetotherapy - eliminates swelling, inflammation of the sciatic nerve, surrounding tissues. Promotes cell regeneration.
• Laser therapy - stimulates blood microcirculation in tissues, capillaries, reduces pain, reduces swelling.
• Electrophoresis - reduces swelling, improves blood supply to tissues. The procedure is carried out with the use of drugs.

Physiotherapeutic manipulations are contraindicated for people with oncological, dermatological, infectious pathologies. It is impossible to carry out procedures for patients suffering from epilepsy, hypertension.

To eliminate the symptoms of inflammation of the sciatic nerve, treatment is prescribed not only during the period of exacerbation. It is also recommended during remission. To avoid the return of the disease or its complications, patients need to undergo preventive treatment at certain intervals, which includes:

• Massage - to get the effect, you need to go through about 10 sessions. The procedure is prescribed to improve blood flow, lymph outflow, reduce swelling, and relieve muscle spasm.
• Manual therapy (according to indications) - eliminates pinching of the sciatic nerve, improves mobility in the lumbosacral region, relieves muscle tone.
• Exercise therapy - physiotherapy exercises are prescribed on the recommendation of the attending physician, a set of exercises is developed individually. The purpose of physical education is to strengthen the muscle corset, maintain the elasticity of the ligaments.

Restorative measures are carried out in the period of stable remission. Physical exercises should gradually become more difficult, and as the muscles strengthen, the number of repetitions increases.

Failed injections

Post-injection neuropathy of the sciatic nerve occurs under the influence of toxic, allergic or mechanical factors. Most often, damage to the nerve trunk is diagnosed with an injection needle, when the injection is not made in the upper outer quadrant of the buttock, but closer to the middle or to the bottom of the gluteal muscle. Symptoms of the lesion may appear gradually or immediately after unsuccessful manipulation.

As the disease worsens, movement disorders are observed, pain syndrome occurs. With a complete lesion of the sciatic nerve, the foot loses its ability to move, swelling, ulcers, bluish color of the skin may appear, it is painful for the patient to step on the foot.

Phased treatment is aimed at restoring the nervous tissue, preventing possible complications in the joints, muscles, tendons, and with a shallow lesion takes no more than 4 weeks. The complex of therapeutic measures includes therapeutic exercises, hydrocolonotherapy, electrophoresis with medications (iodine, lidase), ultrasound treatment, pelotherapy, electrical stimulation, dibazol.

Traumatic lesions

Post-injection neuropathy, the consequences of deep injuries and injuries of the lower extremities are referred to as post-traumatic neuropathy of the sciatic nerve.

The causes of the appearance of pathology are:

• Surgical operations.
• Injuries, injuries (including after injections).
• Blows, bruises, prolonged compression of the nerve.
• Dislocations of joints, fractures of bones.

Symptoms of damage in most cases are as follows:

• Movement and functionality disorders.
• Paralysis is complete or partial.
• Change in sensitivity, change in temperature of the injured limb.
• Decreased muscle tone.
• Possible neuralgia, aggravated by pain syndrome of varying severity.

Treatment of neuropathy of the sciatic nerve of mechanical origin is carried out by conservative methods and is developed on an individual basis. The therapy includes the following activities:

• Acupuncture.
• Hardware and drug stimulation of nerves and muscles.
• Passive forms of physical therapy.
• Reception (intramuscularly, intravenously) of vitamins of group B, as well as C and E.
• In some cases, surgical treatment is indicated.

Damage to the sciatic nerve rarely disables it completely, most often a certain segment of the nervous tissue suffers.

Complications after arthroplasty

Sciatic neuropathy after arthroplasty occurs in less than 1% of operated patients. Pathology is the result of an incorrectly selected endoprosthesis, surgeon's mistakes.

The defeat is divided into two types depending on the mechanism of development:

• Ischemic - a consequence of compression of the nerve trunk by tissues injured during the operation. Manifested in individuals with underdeveloped muscles and subcutaneous fat.
• Traction. When the head of the prosthesis is set into the joint, the surgeon performs hip traction (traction). Excessive tensile force leads to nerve damage

If neuropathy appears immediately after surgery, then this indicates a traction injury. The appearance of symptoms of sciatic nerve neuropathy a few days after the operation indicates the ischemic nature of the disease.

Patients complain of a violation of sensitivity, sometimes a burning pain appears in the foot, the gait changes. The patient cannot stand on the heel, when lifting the leg, the foot sags to take a step, the patient raises the leg high. After the detection of visual symptoms, diagnostics is prescribed - radiography, electromyography.

For the treatment of neuropathy of the sciatic nerve of this type, it is recommended to take groups of painkillers, antispasmodics, antihypoxic drugs, membrane protectors, antiplatelet agents, biostimulants and antioxidants are also needed. Drug therapy is supplemented by therapeutic massage, a course of hyperbaric oxygenation and electrical neuromyostimulation is prescribed.

ethnoscience

Traditional medicine recipes are aimed at eliminating the main symptoms of sciatic nerve neuropathy - pain and inflammation.

Effective external means:

• Honey massage - heat honey (300 g) in a water bath until foam appears, remove from heat, pour medical alcohol (50 g) into hot honey, mix thoroughly. Apply to rub the affected areas, massage with patting movements.
• Soften the beeswax, roll it into a cake of such a size that it completely covers the sore spot, and apply. Fix the compress, warm with a woolen cloth on top, leave overnight.
• Cut the agave leaves lengthwise and apply the soft part to the site of pain localization, secure with a wet bandage.
• Baths with coniferous broth - young shoots of pine, fir, spruce (about 1 kg) pour boiling water (3 l) and boil, insist for 4 hours, strain. Pour the resulting infusion into a warm bath, take about 15 minutes before going to bed.

Taking infusions and decoctions helps to quickly eliminate the symptoms of sciatic nerve neuropathy. Treatment with folk remedies complements medical and physiotherapy

A few recipes:

• Pour a large tablespoon of dried aspen leaves with one glass of boiling water and boil over low heat for 30 minutes. After straining and cooling, use 30 ml / 3 times a day.
• Boil the crushed elecampane root in 200 ml of water over low heat for 5 minutes. After cooling and straining, drink in the morning and evening, dividing the decoction into two equal parts.
• Diuretic compositions normalize metabolism, contribute to the restoration of nerve fibers (broths of wild rose, parsley, calendula, chamomile, etc.).

Prevention

Any active person can get sciatica neuropathy. The history of the disease for everyone begins the same way - acute pain, treatment, remission. Further actions for a full recovery involve preventive measures designed to prevent the recurrence of the disease and improve the health of the patient as a whole.

What will benefit:

• Sanatorium-and-spa treatment in specialized health resorts, where you can take a course of procedures.
• Dosed sports - swimming, Nordic walking, yoga, etc.
• Balanced diet.
• Compliance with the regime of wakefulness and sleep.
• It is necessary to avoid hypothermia, stress, etc.
• Normalize body weight.

Sciatic nerve neuropathy is a rather insidious and serious disease, which is accompanied by a strong pain syndrome, as a result of which it can even lead to temporary disability or even worse, to disability.

Causes and symptoms of the disease

What is the sciatic nerve? This is the longest and most powerful nerve that originates in the lumbar region and ends in the feet of the lower extremities.

Neuropathy of the sciatic nerve occurs due to pinching, inflammation and damage to the roots of the spinal nerves in the lumbosacral spine. The result is pain that is localized in the buttocks and spreads to the extremities. The resulting pain is divided into two main groups: superficial and deep.

Superficial occurs when small nerve fibers are damaged. It can be described as stabbing, raw, burning, in the form of goosebumps.

Deep pain can be described as aching, pulling, cutting and breaking.

Important! The disease affects only one side. In most cases, men have the left, women have the right.

The causes of neuropathy can be different:

Symptoms of neuropathy of the sciatic nerve are diverse and depend on the affected area. Patients may complain about:

• Sharp, burning pain
• Numbness
• Weakness or impaired movement of a limb

In severe cases, the pain is so severe that a person cannot move, and muscle tone decreases. The main provocateurs of such a situation can be stress, injury or hypothermia.

Treatment of the disease

Treatment of neuropathy of the sciatic nerve should be carried out under the supervision of a neuropathologist in a hospital setting. The disease progresses slowly, severely and for a very long time.

The patient must necessarily comply with bed rest (the bed is flat and hard), follow all the recommendations of the doctor. First of all, treatment should be aimed at eliminating the cause of the disease, removing edema, muscle spasms, as well as reducing pain and resuming movement.

For treatment and a positive result, complex therapy is used: ointments, injections, non-steroidal tablets, anti-inflammatory drugs and vitamin therapy.

If the case is more serious, then the doctor may prescribe exercise therapy and various procedures. It can be acupuncture, reflexology, massage or physiotherapy (laser, electrophoresis).

Exercise therapy has a special place in the treatment of neuropathy. A well-chosen set of exercises can reduce trophic disorders, increase blood circulation and prevent muscle weakness.

Quite effective for neuropathy is cupping massage and the use of an orthopedic plaster.

Surgical intervention is performed only in very complex and severe cases, where medical treatment is powerless.

People's Directory

I would like to immediately note that folk remedies play the role of an addition to the main treatment of the disease. From the gifts of nature, you can make therapeutic baths, compresses, ointments, rubbing mixtures, infusions and decoctions for internal use.

Beeswax

The cake is made from beeswax heated in a steam bath. The finished cake should be applied to the affected area. If there is burdock oil, then you can safely add to the wax. This will enhance the effect even better!

Honey and radish juice

Squeeze out the juice from the radish, mix with honey 1:1 and rub into the affected area.

Decoctions

Well helps to cope with the neuropathy of the sciatic nerve decoctions of calendula, parsley and rose hips. Brew as an herbal tea and consume throughout the day in small portions.

Therapeutic baths

In the form of prevention, you can take baths based on a decoction of chamomile, knotweed and sage.

Horse chestnut ointment

Perfectly warms, relaxes. The ointment should be rubbed into the affected area twice a day.

Forecast

The longer the disease proceeds, the less likely it is to get a positive result. The disease entails a lot of complications that are difficult to cope with. In advanced cases, trophic and vasomotor disorders always occur, the toenails are deformed, and the heels and the edge of the feet (in most cases, the outer ones) are affected by trophic ulcers.

No need to neglect treatment! If the cause of the disease is eliminated in a timely manner, then full recovery and freedom of movement for many years is possible.

Important! A disease such as sciatic nerve neuropathy is very insidious, therefore, at the first symptoms of the disease, you should immediately consult a doctor.