Differential Diagnosis in Sciatica Part 2

When you visit a doctor office for a medical concern, the healthcare professional will perform a variety of diagnostic procedures to determine the source of your symptoms. The doctor will review the patient’s current symptoms and medical history as well as the patient’s results from a physical evaluation to diagnose an injury and/or an underlying condition.  

 

Once the healthcare professional has reviewed the patient’s current symptoms, medical history, and results from the physical evaluation, the doctor will make a list of the probable injuries and/or underlying conditions which may be causing the patient’s symptoms. This is the differential diagnosis. A differential diagnosis refers to the process of differentiating between two or more health issues which share similar signs and symptoms. The doctor will perform additional tests or assessments to rule out specific injuries and/or underlying conditions in order to reach a final diagnosis and follow-up with treatment.  

 

The differential diagnosis generally varies depending on the health issue. A variety of health issues can cause common symptoms which may make it challenging to determine the source of the pain and discomfort. Sciatica is a collection of symptoms rather than a single condition which can be a frequent symptom for many health issues. Sciatica is characterized as pain, tingling sensations, and numbness, due to compression or impingement along the length of the sciatic nerve.  

 

Sciatica commonly occurs when an underlying health issue results in the compression or impingement of the sciatic nerve in the lower back. A bulging or herniated disk is one of the most common causes of sciatica. However, a variety of other underlying health issues can cause sciatica and determining what causes sciatica is necessary for proper treatment. In part 2 of this article, we will demonstrate the differences between sciatica and other health issues with similar painful symptoms. 

 

Sacroiliac Joint Dysfunction

 

The sacroiliac joint is generally attributed to causing between 15 to 30 percent of chronic low back pain cases. Irritation, swelling, or inflammation of one or more sacroiliac joints is commonly referred to as sacroiliac joint dysfunction, sacroiliac joint disease, or sacroiliitis. Moreover, sacroiliac joint dysfunction or disease may cause sacroiliitis.  

 

 

Sacroiliac joint dysfunction is characterized as a sharp, stabbing pain which radiates from the pelvis and hips, down into the lower back or lumbar spine and throughout the legs. Patients might experience tingling sensations or numbness. Every person experiences symptoms of SI joint dysfunction differently and the signs can vary from person to person, depending on the source of the sacroiliac joint dysfunction. Common signs and symptoms of SI joint dysfunction include:    

 

• low back pain
• pain in the buttocks, hips, and pelvis
• pain in the groin
• painful symptoms in the SI joints
• pain when standing from a sitting position
• stiffness
• burning sensations
• weakness
• numbness
• pain radiating down into the thighs and legs
• feeling like the legs may buckle and not support the weight of the body

 

Because the joints are situated deep within the human body, it often makes it difficult for healthcare professionals to diagnose the health issue. The healthcare professional may perform a variety of tests to diagnose SI joint dysfunction, such as provocative tests, injections, and/or imaging tests like X-rays, MRIs, and CT scans to be able to follow-up with treatment.  

 

Gluteus Tendinopathy

 

Gluteus medius tendinopathy (GMT), also known as dead butt syndrome (DBS), is a painful health issue caused by the inflammation of the tendons in the gluteus medius muscle. Although GMT most commonly affects athletes, it can also affect people starting a new exercise program, during an intense workout routine or due to an underlying health issue.  

 

The common symptoms associated with gluteus medius tendinopathy, or GMT, include pain and discomfort, stiffness, and weakness in the hip or buttocks region. The painful symptoms can generally worsen throughout weight-bearing exercises, such as walking, running, and/or climbing. For many people, the pain and discomfort associated with dead butt syndrome, or DBS, can radiate down the hips, buttocks, and legs or thighs, similar to sciatica and hamstring tendinopathy. Sciatica is a collection of symptoms characterized by pain and discomfort, tingling sensations, and numbness along the sciatic nerve.  

 

 

Many patients diagnosed with GMT also report experiencing painful symptoms when lying in bed on the affected hip or buttocks region as well as pain, discomfort, stiffness, and weakness throughout the night and upon rising in the morning. Moreover, if DBS progresses past the initial stage, the hip bursa may become inflamed, another health issue known as trochanteric bursitis, which may also cause swelling, tenderness, redness or warmth in the hip, among other health issues.

 

When the tendon becomes inflamed due to an injury or an aggravated underlying condition, such as fibromyalgia, the gluteus medius can fail to trigger appropriately, hence why the “dead butt” term is utilized as an alternate name for this health issue. People sitting down for extended periods of time may cause their hip flexors to become tight and failure to stretch before physical activities can cause DBS. If left untreated, gluteus medius tendinopathy (GMT), or dead butt syndrome (DBS) may lead to complications, including trochanteric bursitis, IT band syndrome, and plantar fasciitis, among other health issues. 

 

Ischiogluteal Bursitis

 

A bursa is a fluid-filled sac which functions by helping to decrease friction around the joints. However, when the fluid inside a bursa becomes infected or irritated due to excessive movement, the bursa can become swollen, causing pain and discomfort, ultimately making it difficult to move the affected joint. This health issue is commonly known as bursitis.  

 

Although bursitis generally occurs in the knee, called “housemaid’s knee”, or in the elbow, called “tennis elbow”, it can occur in any joint in the human body. When it occurs in the buttocks, it is known as ischiogluteal bursitis. In this instance, the bursa is found between the ischial tuberosity at the base of the pelvis and the tendon of the hamstring muscle.  

 

 

The symptoms of ischiogluteal bursitis can be similar to those of hamstring tendonitis. Several of the most common symptoms associated with ischiogluteal bursitis include pain and discomfort as well as tenderness in the buttocks region. Painful symptoms may frequently occur when stretching the hamstring muscle or flexing the knee against resistance.  

 

The symptoms of ischiogluteal bursitis can also be similar to those of sciatic nerve pain. Sciatica is a collection of symptoms characterized by pain, discomfort, tingling sensations, and numbness. While the symptoms of ischiogluteal bursitis may be similar to those of sciatica, sciatic nerve pain occurs when the sciatic nerve is irritated, compressed or impinged due to an injury and/or an aggravated condition. Ischiogluteal bursitis caused by an infection can ultimately be followed by a fever.  

 

The three most common causes of bursitis are generally due to injury or trauma, infection, and crystal deposits. Trauma can include repetitive movements or a blow to the region. By way of instance, the injury could occur due to a fall. Occasionally, trauma or injury can cause blood to leak into the bursa, causing ischiogluteal bursitis, or any other type of bursitis.  

 

Infection septic bursitis, or an infection in the bursa, generally occurs in the joints which are located closer to the surface of the human body. This health issue frequently affects men, however, it does not seem to be a leading cause of ischiogluteal bursitis. Crystal deposits can also form around the joints when there is too much uric acid in the human body. People with gout can develop bursitis because it is also caused by crystal deposits and it shares many similar symptoms with bursitis.  

 

Proximal Hamstring Injury

 

Hamstring injuries are several of the most common types of injuries among athletes. These makeup for the most days or even weeks missed each year amongst AFL football players. The majority of partial or complete tears include either the hamstring muscle belly or the distal musculotendinous junction. However, a proximal hamstring injury is ultimately uncommon. In the total hamstring injury spectrum, it makes up for under 10 percent of hamstring injuries, among other health issues.  

 

The proximal hamstring tendon can become injured through progressive stretching or through sudden and intense contraction when the hip is forcefully flexed over an extended knee. In younger patients with an average proximal hamstring tendon, this can occur through sprinting or hurdling, however, the most common athletes affected in this instance involves waterskiiers who fall forward with an extended knee. In elderly patients, proximal hamstring injuries occur through a different type of trauma, such as slipping on a wet surface or even doing the “splits” inadvertently.  

 

Proximal hamstring injuries could include complete tendon ruptures or incomplete/partial tears. In young patients, the bone together with the tendon is frequently avulsed or fractured in the pelvis or the ischium. In older patients, the tendon usually avulses or tears from the bone of the ischium at its attachment point. Occasionally, the tendon may tear in its midsubstance, leaving a stump of tendon still attached to the bone. Frequently this type of injury is referred to as a partial tear.  

 

 

Adductor Injuries

 

An adductor muscle strain is characterized as an acute injury to the muscles of the groin. Although a variety of muscles in the human body can be injured, the adductor longus, medius, magnus, and the gracilis are some of the most well-known muscle groups to be affected by an injury.  According to healthcare professionals, atrains are muscle tears which generally occur due to the powerful contraction of the muscles against resistance, often during what is referred to as an eccentric load.  

 

 

An adductor muscle strain occurs during acute muscle contraction, such as during kicking, pivoting or skating. Factors which can predispose a person to injury include failure to properly stretch or warm up and fatigue from overuse. The risk of experiencing an adductor strain increases with sports involving strides like sprinting, soccer, and hockey. Sports with repeated movements like football, martial arts, and gymnastics can also substantially increase the risk of experiencing an adductor strain. Struggling to warm up, stretch or be properly conditioned can also cause an adductor muscle strain.  

 

The symptoms associated with an adductor muscle strain most commonly involve a variety of painful symptoms which are most frequently related to other types of muscle strain. Common symptoms of an adductor muscle strain include a sudden onset of pain and discomfort, occasionally accompanied by the feeling of a pop in the inner section of the thigh as well as the inability to maintain action after the first onset of painful symptoms. Because an adductor strain may cause groin or hip pain, many patients and healthcare professionals may confuse this type of injury with sciatica or sciatic nerve pain.  

 

Adductor tendinopathy is generally characterized as pain on palpation of the adductor tendons, adduction of the legs and/or of the injured leg. Pain can develop gradually or cause a sudden and severe, sharp pain. A swelling or a lump may also be experienced from the adductor muscle(s), stiffness at the groin area or an inability to contract or extend the adductors. In acute cases, exercises and physical activities will be restricted because the tendon can’t sustain repeated tensile loading.  

 

 

The adductors are triggered in many sports such as, running, soccer, horse riding, gymnastics, and swimming. The repetitive movements and the continuous change of direction in physical activities activate the adductor tendon, which makes athletes more prevalent to develop adductor tendinopathy and other groin injuries. Other causes of adductor tendinopathy can include over-stretching of the adductor tendons or a sudden increase in training, especially in the type of training.  

 

Adductor tendinopathy may occur due to considerable leg length discrepancy which affects gait pattern. Poor or abnormal movement patterns may also overly stress the adductor tendons. Muscular length gaps, strength imbalances or muscular weakness in the thoracic or the abdominals can also be powerful in developing adductor tendinopathy. Other causes include a failure to properly warm-up, inactivity, fatigue, obesity, age-related weaknesses, genetics or degeneration.  

 

Spinal Tumors

 

Most back pain is caused by other health issues. However, when painful symptoms are caused by spinal tumors, it’s essential for a healthcare professional to perform an accurate diagnosis to follow-up with proper treatment. There are three types of tumors which can cause back pain; vertebral column tumors, intradural-extramedullary tumors, and intramedullary tumors.  

 

 

Tumors in the spine can cause back pain when the growth weakens the bone, which can ultimately result in spinal fractures, compression or impingement of the nerves, and spinal distress. Spinal tumor symptoms may ultimately be similar to those of other well-known health issues, including sciatica, especially if the spinal tumor irritates the sciatic nerve.  Furthermore, the following symptoms below may ultimately be commonly associated with a spinal tumor, including:  

 

• Neck pain or back pain followed by neurological health issues, such as tingling sensations, weakness, and numbness in the upper and lower extremities as well as abnormal bladder and bowel habits.
• Painful symptoms, particularly in the morning
• Severe pain with manipulation of the affected region of the spine
• Painful symptoms which do not decrease with rest
• Back pain and other associated symptoms, such as loss of appetite, nausea, vomiting, weight loss, fever, or chills.

 

If any tumor is located in the spine and if there’s no other known cancer, a healthcare professional may perform a series of comprehensive evaluations and additional testing of all common organs in which cancer can develop. Because many vertebral column tumors originate from cancer in another organ, the ultimate goal of spinal tumor treatment is to:    

 

• Regulate severe painful symptoms which occur with these spinal tumors by removing pressure on the nerve roots
• Maintain neurological structure and function by removing pressure on the spinal cord
• Correct structural and functional instability in the spine by correcting the unstable spine with a spinal fusion

 

As previously mentioned, when you seek medical attention for a health issue, it’s essential for the healthcare professional to accurately diagnose your medical concern in order to follow-up with the proper treatment. A differential diagnosis is a list of possible injuries and/or underlying conditions which may be causing symptoms. Sciatica, a group of signs and symptoms commonly characterized by pain, discomfort, tingling sensations, and numbness, is a well-known health issue which can have many differential diagnosis. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

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Fibromyalgia Magazine

 

 

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The purpose of the article was to discuss the differential diagnosis in sciatica with a variety of other health issues. Accurate diagnosis and proper treatment are important for sciatic nerve pain management. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 .  

 

Curated by Dr. Alex Jimenez  

 

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Additional Topic Discussion: Severe Sciatica

 

Back pain is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. Your spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of sciatica, or sciatic nerve pain. Sports injuries or automobile accident injuries are often the most frequent cause of painful symptoms, however, sometimes the simplest of movements can have these results. Fortunately, alternative treatment options, such as chiropractic care, can help ease sciatic nerve pain, or sciatica, through the utilization of spinal adjustments and manual manipulations, ultimately improving pain relief.  

 

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