Defeat n. ischiadicus, manifested by acute shooting or burning pain along the back of the thigh, weakness of flexion of the leg at the knee, numbness of the foot and lower leg, paresthesia, paresis of the muscles of the foot, trophic and vasomotor abnormalities in the lower leg and foot. The disease is diagnosed primarily based on the results of a neurological examination, electrophysiological studies, CT, radiography and MRI of the spine. In therapy sciatic neuropathy, along with eliminating it etiological factor, carry out medicinal and physiotherapeutic treatment, supplemented by massage and physical therapy (including post-isometric relaxation).

General information

Neuropathy sciatic nerve- one of the most common mononeuropathies, second only to neuropathy of the peroneal nerve in its frequency. In most cases it is one-sided. It is observed mainly in middle-aged people. Morbidity among age group 40-60 years old is 25 cases per 100 thousand population. It is equally common in females and males. There are often cases when sciatic neuropathy seriously and permanently reduces the patient’s ability to work and even leads to disability. In this regard, the pathology of the sciatic nerve seems to be a socially significant issue, resolution medical aspects which is under the jurisdiction of practical neurology and vertebrology.

Anatomy of the sciatic nerve

The sciatic nerve (n. ischiadicus) is the largest peripheral nerve trunk in humans, its diameter reaches 1 cm. It is formed by the ventral branches of the lumbar L4-L5 and sacral branches S1-S3 spinal nerves. Having passed the pelvis along its inner wall, the sciatic nerve, through the notch of the same name, exits to the posterior surface of the pelvis. Then it goes between the greater trochanter of the femur and the ischial tuberosity under the piriformis muscle, exits onto the thigh and above the popliteal fossa divides into the peroneal and tibial nerve s. The sciatic nerve does not give off sensory branches. It innervates the biceps, semimembranosus and semitendinosus muscles of the thigh, which are responsible for flexion. knee joint.

In accordance with the anatomy of n. ischiadicus, there are several topical levels of its involvement: in the pelvis, in the area of ​​the piriformis muscle (the so-called piriformis syndrome) and on the thigh. The pathology of the terminal branches of the sciatic nerve is described in detail in the articles “Neuropathy of the peroneal nerve” and “Neuropathy of the tibial nerve” and will not be discussed in this review.

Causes of sciatic nerve neuropathy

A large number of sciatic neuropathies are associated with nerve damage. Injury n. ischiadicus is possible with a fracture of the pelvic bones, dislocation and fracture of the hip, gunshot, laceration or incised wounds of the thigh. There is a trend towards an increase in the number of compression neuropathies of the sciatic nerve. Compression may be caused by a tumor, iliac artery aneurysm, hematoma, long-term immobilization, but most often it is caused by compression of the nerve in the infrapiriform space. The latter is usually associated with vertebrogenic changes occurring in the piriformis muscle according to the reflex muscular-tonic mechanism during various pathologies spine, such as: scoliosis, lumbar hyperlordosis, spinal osteochondrosis, lumbar spondyloarthrosis, hernia intervertebral disc etc.

According to some data, approximately 50% of patients with discogenic lumbar radiculitis have clinical symptoms of piriformis muscle syndrome. However, it should be noted that neuropathy of the sciatic nerve of vertebrogenic origin may be associated with direct compression of the nerve fibers as they exit spinal column as part of the spinal roots. In some cases, pathology of the sciatic nerve at the level of the piriformis muscle is provoked by an unsuccessful injection into the buttock.

Inflammation (neuritis) n. ischiadicus can be observed in infectious diseases (herpes infection, measles, tuberculosis, scarlet fever, HIV infection). Toxic damage possible both with exogenous intoxication (arsenic poisoning, drug addiction, alcoholism), and with the accumulation of toxins due to dysmetabolic processes in the body (diabetes mellitus, gout, dysproteinemia, etc.).

Symptoms of sciatic nerve neuropathy

A pathognomonic symptom of neuropathy n. ischiadicus causes pain along the affected nerve trunk, called sciatica. It can be localized in the buttock area, spread from top to bottom along the back of the thigh and radiate along the posterior outer surface of the leg and foot, reaching the very tips of the fingers. Patients often describe sciatica as “burning,” “shooting,” or “piercing like a dagger.” The pain syndrome can be so intense that it prevents the patient from moving independently. In addition, patients report a feeling of numbness or paresthesia on the posterolateral surface of the leg and some areas of the foot.

Paresis is objectively detected (decreased muscle strength) biceps, semimembranosus and semitendinosus muscles, leading to difficulty bending the knee. In this case, the predominance of the tone of the antagonist muscle, which is the quadriceps femoris muscle, leads to the position of the leg in a state of extended knee joint. Walking with a straight leg is typical - when moving the leg forward for the next step, it does not bend at the knee. Paresis of the foot and fingers, decreased or absent plantar and Achilles tendon reflexes are also noted. When enough long term disease, atrophy of paretic muscle groups is observed.

Pain sensitivity disorders cover the lateral and posterior surface of the lower leg and almost the entire foot. In the area of ​​the lateral malleolus there is a loss of vibration sensitivity, in interphalangeal joints feet and ankles - weakening of muscle-joint sensation. Typical pain is when pressing on the sacrogluteal point - the exit point n. ischiadicus on the thigh, as well as other trigger points of Valle and Gar. A characteristic feature sciatic neuropathy is positive symptoms Bonnet tension (shooting pain in a patient lying on his back with passive abduction of the leg bent in hip joint and knee) and Lassegue (pain when trying to lift a straight leg from a supine position).

In some cases, sciatic nerve neuropathy is accompanied by trophic and vasomotor changes. The most pronounced trophic disorders are localized on the lateral side of the foot, the heel and the back of the toes. Hyperkeratosis, anhidrosis or hyperhidrosis may occur on the sole. Hypotrichosis is detected on the posterolateral surface of the leg. Due to vasomotor disturbances, cyanosis and coldness of the foot occur.

Diagnosis of sciatic nerve neuropathy

The diagnostic search is carried out mainly as part of a neurological examination of the patient. Special attention The neurologist pays attention to the nature of the pain syndrome, areas of hypoesthesia, decreased muscle strength and loss of reflexes. Analysis of these data allows us to determine the topic of the lesion. Its confirmation is carried out using

The nervous system is the most important system that permeates the entire body. , neuropathy of the sciatic nerve, lumbosacral radiculitis - one of the types of damage nervous system, in which the sciatic nerve is pinched or pinched.

A little anatomy

An important nerve - the sciatic - begins in the lumbar region, passes through the tailbone, going down the lower limbs to the feet. Reaching the popliteal fossa, this nerve divides into two parts - the tibial and peroneal nerves.

In most cases, one or another part of the sciatic nerve suffers from inflammation. Sometimes many nerves are affected at the same time, which is called polyneuropathy.

Neuropathies are divided into the following forms:

• toxic,
• traumatic,
• post-traumatic,
• mixed,
• compression-ischemic,
• post-injection.

How to recognize sciatica?

A common sign of sciatic nerve neuropathy is increasing pain in the back of the leg. However, the symptoms of sciatica can vary:

• Pain may occur in the hips, knees, reach the feet, or even the fingertips.
• Appears muscle weakness or .
• Often the pain occurs locally - a strong lumbago on any part of the sciatic nerve.
• There is a loss of sensitivity and motor activity legs
• The pain can be burning, shooting or aching. Duration – from several days to 2-3 months.

Sciatica is extremely rare in children. However, if you notice the above symptoms in your child, urgent consultation with a doctor is necessary.

Since the signs of sciatica can be vague, recognizing it is sometimes quite difficult. That is why it is necessary to immediately contact a specialist and undergo a clinical and neurological examination.

Why does sciatica occur?

Among the factors, the most common is spinal diseases. Among them:

• spondylolisthesis,
• dysfunction of the sacroiliac joint.

Benign and malignant tumors in the spine give rise to . Among the secondary reasons are hypothermia, gynecological diseases, diabetes, arthritis.

Sciatica can also occur as a consequence infectious diseases: or tuberculosis. This happens viral infection sacral plexus nerve

How to treat sciatica: traditional and non-traditional methods.

Treatment of the sciatic nerve is aimed at eliminating pain, relieving inflammation in the nerves, and strengthening muscles. You cannot tolerate the pain of sciatica, as it will only get worse in the future.

At an advanced stage, the disease will interfere normal functioning lower limbs. possible, but it is recommended to do this after visiting and examining a doctor.

Exercise therapy

For this disease, only a specialist can prescribe it, determining the causes of the disease. First priority treatment of pathology - . An approximate set of exercises will help with this. It includes these exercises:

1. Lie on your back, bend your knees, place your feet on the floor, cross your arms over your chest. As you inhale, lift your body so that your shoulders come off the floor. As you exhale, return to the starting position. Repeat the exercise 15 times without a break.
2. Starting position: lying on your stomach. You need to rest on slightly bent elbows. Stretch your back as much as possible for 10-15 seconds. Perform the exercise 10-15 times.
3. Wall push-ups, as a lighter version of push-ups, help to bend the lumbar spine without stress. Standing facing the wall, place your palms shoulder-width apart. As you inhale, bend your elbows, and as you exhale, return to the starting position. The exercise must also be performed 10-15 times.
4. If pain does not allow you to perform complex exercises, you can perform a light exercise in a sitting position. Sit on a chair and cross your legs. Then straighten your back and place your hands behind your head. Make 5-10 turns in each direction.

Massage treatments

For sciatica, it is performed daily or every other day. It helps relieve pain and stretch muscles. Use gentle massaging movements without causing acute pain. Doctors recommend acupuncture or vacuum massage.

Folk recipes

Sciatica includes:

• Including sauerkraut in your diet.
• Tea made from bean shells.
• A decoction of aspen leaves.
• Compresses made from rye dough, or.

Consequences of the disease

The effects of sciatica can lead to complete numbness of the leg. The most dangerous complication neuropathy of the sciatic nerve is a violation of the fixation of the vertebrae, which under load can lead to displacement, and this, in turn, inevitably requires surgical intervention.

Incorrect diagnosis or treatment of sciatica can lead to complications such as paresis and paralysis. Damage to the foot manifests itself in paresis or damage to the peroneal nerve.

Traction injuries to the sciatic nerve can lead to peroneal neuropathy, which subsequently results in foot drop and difficulty walking on your heels.

Lesions of the tibial nerve most often develop as a result of trauma, which also leads to disturbances in the functioning of the foot, in particular, its flexion. Foot paresis is a defect in which the foot does not rise and drags when walking.

Many people wonder whether inflammation of the sciatic nerve gives disability. Disability at various forms Damage is extremely rare. Statistics show: from total number 1.3 percent of those suffering from sciatica received permanent disability, of the third group.

Among 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 the most common.

The damaging effect is caused by toxic, allergic and mechanical factors - the impact of a needle. Damage to the nerve trunk, as already mentioned, is possible due to its direct trauma with an injection needle, or through the compression-ischemic effect of surrounding tissues containing post-injection: hematoma, bruise, infiltrate or abscess.

Similar lesions have been described with the administration of salvarsan, mercury, camphor, bioquinol, quinine, antibiotics, magnesium sulfate, cocarboxylase, vitamin K and others medicines(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, 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.

Let's look at post-injection neuropathy using the example of damage to the sciatic nerve. Damage to the sciatic nerve occurs when injections are made not in the upper outer quadrant of the buttock, but closer to the middle and bottom, or when the injection site is correctly chosen, but with an oblique rather than perpendicular direction of the needle.

Clinical manifestations may be acute immediately after injection or develop gradually over several weeks. Movement disorders prevail over sensory disorders, pain is rare. An equinovarus position of the foot develops, which hangs down, abduction and extension of the toes are impossible (the function of the peroneal nerve is lost). Absence of the Achilles reflex while maintaining incomplete active adduction and flexion ankle joint indicates damage to the tibial nerve. With deep (total) lesions of the sciatic nerve, movement in the foot is completely absent (the clinical picture is similar to “paralyzing sciatica”).

A significant difference between paretic manifestations due to damage to the sciatic nerve and similar paresis of radicular origin is the vegetative-vascular and trophic components. The foot becomes swollen, dark bluish, and the 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 (“like pebbles”) with the frequent absence of hypalgesia. Trophic disturbances are pronounced.

Along with atrophy of the muscles of the 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 persistent fixation of the foot in a vicious position. In such cases, recovery is delayed for months and years; in approximately 12% of patients it does not occur. For mild nerve damage recovery period may be limited to 1 – 4 weeks.

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

Approximate timing of regeneration of nerve trunks according to G.S. Kokin and R.G. Daminov (1987) are as follows: lateral triangle of the neck, subclavian and axillary areas - 6 - 12 months, shoulder level - 4 - 9 months; forearm level – 3 – 9 months; hip level: sciatic nerve – 12 months, femoral nerve– 6 – 12 months; lower leg level: peroneal nerve – 6 – 12 months. At this stage, to prevent gross scarring, electrophoresis of lidase, iodine, ultrasound (with partial damage nerve), peloid therapy (mud, paraffin, ozokerite), electrical stimulation of nerves; Dibazol.

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

Injury and compression of nerve trunks, accompanied by a violation of anatomical integrity, are subject to surgical treatment– neurorrhaphy (suturing of nerve trunks), neurolysis and neurectomy.

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

But it must be remembered that joint use venlafaxine and gabapentin reduce the effectiveness of these drugs in neuropathic pain syndrome. Yes, in conditions experimental model pain (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 accompanied by a decrease in allodynia. The simultaneous administration of both drugs led to a significant decrease in the antiallodynic effect (source: recommendations for doctors “The use of antidepressants for the treatment of patients with chronic pain syndromes» Kamchatnov P.R. Professor, Doctor of Medical Sciences, Department of Neurology and Neurosurgery, State Educational Institution of Higher Professional Education, Russian State Medical University named after. N.I. Pirogov; Moscow, 2009, p. 12).

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IN modern medicine neuritis of the sciatic nerve is very actual problem. This is an extensive lesion and inflammation of nerve fibers, which leads to a pronounced impairment of sensitivity and movement disorders. This pathology affects up to 70% of the world's population. Every patient should know how to treat this dangerous disease.

Localization and significance of the sciatic nerve

This is the largest nerve human body, which controls leg movements. It allows us to jump high, run fast, and walk confidently. If a person has scuff marks from tight shoes, or his feet are frozen, then painful sensations transmitted to the brain through this nerve. Its zone begins in the two lower lumbar vertebrae. The complex sciatic nerve is formed from five nerve roots and merges into one powerful trunk with a diameter of up to 1 cm.

Its motor and sensory fibers are formed by motor neurons spinal cord and peripheral nerve cells. Sensitivity skin, joints, and muscles of many parts of the lower body are provided by the sciatic nerve. The nerve endings arise from the spinal cord in the lower part of the spine, passing through the last two lumbar vertebrae and the four sacral foramina. The nerve then travels to the greater sciatic foramen.

Inside pelvic bones there are piriformis muscles that go from the sacrum to the greater trochanter femur. These muscles cover the sciatic nerve, which, through a narrow gap under the piriformis muscle, runs along the back of the thigh to the popliteal fossa and divides here into two branches. They go further and innervate the muscles of the leg.

Causes of sciatic nerve neuritis

Factors provoking the development of pathology:

1. Pinched sciatic nerve is the main cause.
2. This can happen under the influence of various factors.
3. Muscle spasms and pinched nerves as a result of increased physical activity on the spine.
4. Inflammatory process, infection of nerve fibers, joints, and surrounding soft tissues.
5. Hypothermia of the lumbar region, seasonal viral infections, cold.
6. Displacement of the vertebrae during pregnancy, lumbar injuries due to blows, bruises, falls.
7. Osteochondrosis, intervertebral disc herniation lumbar region causes very severe pain.
8. Mechanical damage as a result of incorrectly done intramuscular injection to the buttock area.
9. Infectious diseases: tuberculosis, rheumatism, arthritis.

Pathogenesis of the disease

The mechanism of development of the disease is associated with dysfunction of nerve cells:

1. The sciatic nerve contains sensory and motor fibers.
2. The body reacts to problems with a pinched nerve by fixing the sore spot.
3. They suffer here blood vessels, blood flow is disrupted, swelling increases. Therefore, compression of the radicular nerves in 95% of cases occurs as a result of edema, which is defensive reaction body for inflammation and damage.
4. As a result muscle spasms and compression of the nerves, pain appears at the site of the sacroiliac joint, and dystrophic changes develop.

Clinical picture of the disease

The pathology occurs suddenly, its symptoms gradually develop:

1. A pinched nerve causes shooting, burning, stabbing pain.
2. Sciatica - acute pain in the lower back and along the sciatic nerve radiates to the buttock, then to the back of the thigh and popliteal fossa. Further, this alarm signal from our body often spreads to the lower leg, foot to heel.
3. The patient feels numbness, tingling, muscle contractions or pain of varying intensity when moving.
4. It can be aching or sharp, similar to the sensations of an electrical injury.
5. This causes severe attacks pain. A person cannot lie, sit, walk, or sleep.

Diagnosis of pathology

Treatment begins with determining the cause of the disease and establishing a diagnosis. A patient who first feels the symptoms of this disease needs to consult a vertebrologist or neurologist. The specialist will recommend painless and safe methods examinations. They help determine the degree of tissue change and the cause of nerve damage.

Proven diagnostic procedures are used:

1. X-ray.
2. Magnetic resonance imaging.

Normally, there should be no pain when straightening the leg. For doctors, the Lasègue symptom is a clear neurological sign; it serves to assess the degree of damage to the sciatic nerve. The patient lies on his back. The doctor bends his leg at a right angle and then begins to straighten it. Pain in the knee joint when extending the leg indicates a dysfunction of this plexus of nerve fiber bundles. Based on the angle of leg extension at the moment of pain, the doctor judges the degree of pathology of the sciatic nerve.

Effective treatment of sciatic nerve sciatica

Basic principles of therapy:

1. To prevent the development of complications, treatment must begin immediately after the first symptoms appear.
2. The treatment strategy is selected by the doctor after assessment clinical picture, establishing a diagnosis, determining the causes of the disease and the extent of tissue damage.
3. If the disease is traumatic, surgical intervention may be required.
4. If sciatic nerve neuritis is of infectious origin, antibacterial and antiviral drugs are prescribed to influence the identified pathogen.
5. The most important links of the combined traditional treatment is to eliminate the causes of the disease and anti-inflammatory therapy.
6. Alternative medicine methods are used.

Complex therapy for radicular compression of nerves in the sacrum and lumbar region

First aid. To relieve pain and be able to get to the doctor, the patient can take aspirin.

The doctor, taking into account the diagnostic data of sciatic nerve neuritis, symptoms, prescribes adequate treatment.

1. During the 1st week of exacerbation of the disease, you must strictly adhere to bed rest. The affected area should be kept completely at rest.
2. Vitamin therapy is effective for this disease. The prescription of combilipen - B vitamins - is required.
3. Painkillers will help relieve inflammation and pain. Short courses of treatment with universal, highly effective non-steroidal anti-inflammatory drugs are used. They have analgesic, anti-edematous and antipyretic effects. These medications improve metabolism in soft tissues, nerve cells. These are diclofenac, ketoprofen, naprofen, sulindac, indomethacin.
4. If muscle tone decreases from the second week, it is advisable to use proserin to improve neuromuscular conduction.
5. For the purpose of complete recovery, after 3 months they are prescribed biogenic stimulants PHYBS, aloe extract.
6. In order to resolve the inflammatory focus, the enzymatic agent lidase is prescribed. It stimulates metabolic processes in the body.

Helps effectively therapeutic massage. It is prescribed a week after the onset of the disease. This healing procedure is necessary to relax the muscles innervating the affected nerve.

Physiotherapeutic treatment:

1. From the first days of illness, non-contact thermal procedures are indicated: short-wave diathermy.
2. A course of 8-10 microwave therapy procedures.
3. UHF is prescribed 5-6 days after an exacerbation of the disease.
4. From the end of the second week, more intensive physiotherapy is advisable: hydrocortisone phonophoresis, ultrasound.

Manual therapy:

1. With this treatment method chiropractor spreads the lumbar vertebrae.
2. Movement between the vertebrae is restored to unblock the affected area and improve blood flow.

Exercise therapy - therapeutic exercises:

1. With a purpose speedy recovery nerve fibers during remission this is used effective method treatment that will help avoid exacerbation.
2. Special therapeutic exercises with gradually increasing load improve muscle tone and increase blood circulation in the affected area.
3. The most lightweight starting positions that do not cause pain are required.

Exercises for neuritis of the sciatic nerve:

1. Starting position: lying on your back. The patient clasps his knees with his hands and pulls them to his chest. The pelvis comes off the mat. You need to lie on your lower back for 1 minute.
2. In the same starting position bend your legs and raise them 90° to your body. Place your hands at your sides. Without lifting your shoulder blades, you should exhale and slowly turn your bent legs to the side at least 45 degrees to the floor surface. Hold your legs in this position for 3 seconds. Inhale and slowly turn your legs in the other direction.
3. The original position is maintained. Raise one leg, bending it at the knee. Holding it with your hand, slowly and carefully move your leg as far as possible to the side. Pull your knee towards you. The free leg is extended.
4. Lying on your back, place both hands under your lower back. Straight legs should be raised 90° and exercises should be performed that simulate cycling and scissoring movements.
5. Standing upright, move your pelvis back and forth.

If a person notices signs of illness, he should immediately consult a doctor.

The doctor, taking into account the diagnostic data, will select adequate treatment taking into account the reasons that caused the development of the disease. Nerve function will be restored. The chances of success will be greater if the patient receives the doctor’s recommendations as early as possible.