Back pain, pain in the buttocks

Lower back pain, accompanied by pain in the buttock bones, is usually a symptom of sciatica. Sciatica is a very common disease. Since it occurs on the bones, once it occurs, it will cause great pain to the patient and make it unbearable. There are many symptoms of sciatica. Below we will introduce them in detail so that you can determine whether you have sciatica.

1. General symptoms

(1) The pain is mainly limited to the sciatic nerve distribution area, the posterior thigh, the posterior and lateral part of the calf, and the foot. Patients with severe pain may adopt a unique posture: bending their waist, bending their knees, and standing on their toes. If the lesion is located at the nerve root, the pain will worsen when the pressure in the spinal canal increases (coughing, straining).

(2) The degree of muscle weakness can vary greatly depending on the cause, location of the lesion, and the extent of the damage. The muscles innervated by the sciatic nerve may be completely or partially weak or paralyzed.

(3) There may or may not be tenderness over the sciatic nerve trunk at the sciatic notch.

(4) There is a sciatic nerve traction sign, and the Lasegue sign and its equivalent sign are positive. The presence of this sign is often parallel to the severity of the pain. This symptom may disappear after local anesthesia of the sciatic nerve root or nerve trunk.

(5) The Achilles tendon reflex is reduced or disappears, and the knee reflex may increase due to stimulation.

(6) There may be a decrease or disappearance of various sensations in the area innervated by the sciatic nerve, including a decrease in vibration sensation at the lateral ankle, or there may be very mild sensory impairment.

2. Sciatica

It is often accompanied by various types of infections and systemic diseases, such as upper respiratory tract infections. Because the sciatic nerve is relatively superficial, sciatica is prone to occur when exposed to moisture or cold. When sciatica occurs due to systemic diseases, attention should be paid to the presence of complications such as collagen disease and diabetes.

Most cases of sciatica are unilateral and not accompanied by waist or back pain. The pain is usually continuous but can also be paroxysmal. Symptoms worsen when spinal canal pressure increases and can also radiate along the sciatic nerve. There is obvious tenderness in the sciatic nerve trunk and gastrocnemius tenderness. The pain and muscle weakness are often not parallel. The pain is generally severe, while the muscle weakness is often not obvious. In the acute phase, it is difficult to judge motor function due to pain. Foot drop and atrophy of the gastrocnemius and tibialis anterior muscles may be detected. The Achilles tendon reflex is reduced or absent, but the Achilles tendon reflex may also be normal. The knee reflex is normal, and superficial sensory impairment is obvious.

3. Secondary sciatica

(1) Lumbar disc herniation

It is the most common cause of sciatica, often occurring at L4-L5 and L5-S1. About 1/3 of cases have a history of acute lumbar trauma. Most patients are between 20 and 40 years old. The clinical characteristics are low back pain for weeks or months, and then sciatica in one lower limb. In addition to the general symptoms of sciatica, physical examination also showed tension in the back muscles, limited lumbar movement, scoliosis, and tenderness of the spinous processes at the affected area.

(2) Lumbar osteoarthritis

It is more common in people over 40 years old, with a subacute to chronic onset, and most have a history of long-term low back pain, difficulty standing up after sitting for a long time, and difficulty sitting down after standing for a long time. Clinically, it can manifest as sciatica on one or both sides and low back symptoms.

(3) Congenital malformation of lumbar spine

Lumbar sacralization, sacral lumbarization, and occult spina bifida. The latter, in addition to sciatica, often has a history of enuresis. Physical examination often shows foot deformities and abnormalities of the lumbar and sacral skin, such as the small depression behind the anus and small hemangiomas on the midline of the sacrum. This often objectively and accurately indicates the area where the vertebral lamina has not healed.

(4) Sacroiliitis

Common causes include rheumatoid and tuberculous lesions. When there is exudation and destruction of the joint capsule, it will stimulate the L4-5 nerve trunks, and some patients may have symptoms of sciatica.