Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy

Abstract

Introduction: In this study we sought to characterize etiologies and features of sciatic neuropathy unrelated to penetrating nerve trauma. Methods: This investigation was a retrospective review of 109 patients with electrodiagnostically confirmed sciatic neuropathies. Results: Hip replacement surgery represented the most common (34.9%) etiology, whereas inflammatory sciatic neuropathy was seen in 7.3%. Electrodiagnostic testing revealed an axonal neuropathy in 95.4% and a demyelinating neuropathy in 4.6%. Predominant involvement of the peroneal division was seen in 39.4% and was tibial in 5.5%. Nine of 31 (29.0%) patients who had MRI or neuromuscular ultrasound study showed abnormalities within the sciatic nerve. At the final visit, 46.4% of patients required assistance for ambulation. Young age, lack of severe initial weakness, and presence of tibial compound muscle action potential or sural sensory nerve action potential were predictors of favorable outcome. Discussion: Sciatic neuropathies are usually axonal on electrodiagnostic testing, affect preferentially the peroneal division, and are commonly associated with incomplete recovery.Muscle Nerve 59:309-314, 2019Additional supporting information may be found in the online version of this article.

Sciatic neuropathy with preserved sensory nerve action potentials, a case series

“…This group of patients with sciatic neuropathy was mostly young, and had a higher female to male ratio when compared to previous studies. 2,4 Yuen et al 2 previously reported that most of their patients with intact SNAPs revealed mild axonal loss changes with normal or near normal CMAP amplitudes. In our study, a reduction of CMAP amplitude was observed in 10 patients, and sensory sparing were seen in patients with both mild (e.g., patient 5) and severe (e.g.…”

“…Limited data on 4 patients were included in one prior publication. 4 Sensory complaints of paresthesia, numbness and pain were present in all patients. On exam, reduction of pinprick and/or touch sensation was documented in 10 patients, reduction of vibration sensation in 2, and normal sensory exam in 1.…”

“…Due to sciatic nerve's large size, either the peroneal (fibular) or the tibial branch could be preferentially affected while leaving the other branch relatively spared. [1][2][3][4] However, sciatic neuropathy affecting predominantly motor or sensory branches has not been well characterized. In the current study, we describe 12 patients with sciatic neuropathy showing preserved sensory responses on nerve conduction studies (NCS).…”

The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020)

“…Perioperative sciatic nerve lesions usually result in weakness of the dorsiflexor muscles of the foot. Other muscles supplied by the sciatic nerve, especially the knee flexor muscles, are often only affected at a subclinical level [42]. This also applies to sensory deficits; hypesthesia of the lateral aspect of the calf and across the entire foot with the exception of the medial aspect only occurs in the context of severe injury.…”

Cane sign: sciatic neuropathy appearance in magnetic resonance imaging

“…1 Drop-foot may be associated with many clinical syndromes, so electrophysiological examinations and imaging studies, as well as clinical and neurological examination findings, are essential in the differential diagnosis. 1,2 Trauma, surgery, injections, infections, inflammation, vascular events, or tumors can cause sciatic neuropathy and up to 16% of cases, it can be idiopathic. 1,3 If any, treatment of the underlying cause, immunosuppressive and supportive treatments, and physical therapy applications can be beneficial.…”