Differential Diagnosis in Sciatica Part 2

When you visit a doctor’s office for a medical concern, the healthcare professional will perform various 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 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 underlying conditions that may be causing the patient’s signs. This is the differential diagnosis. A differential diagnosis refers to the process of differentiating between two or more health issues that share similar signs and symptoms. The doctor will perform additional tests or assessments to rule out specific injuries and underlying conditions to reach a final diagnosis and follow up with treatment.  

 

The differential diagnosis generally varies depending on the health issue. Various 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, and it can frequently occur as a symptom associated with various 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, various 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

Experts generally attribute between 15 and 30 percent of chronic low back pain cases to the sacroiliac joint. 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 that 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 various tests to diagnose SI joint dysfunction, including provocative tests, injections, and imaging techniques such as X-rays, MRIs, and CT scans, in order to determine the appropriate 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 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 beyond the initial stage, the hip bursa may become inflamed, leading to a condition known as trochanteric bursitis, which can also result in swelling, tenderness, redness, or warmth in the hip, among other related 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, 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 not treated, gluteus medius tendinopathy (GMT), or dead butt syndrome (DBS), can cause problems like trochanteric bursitis, IT band syndrome, and plantar fasciitis, along with other health issues.

 

 

 

 

Ischiogluteal Bursitis

A bursa is a fluid-filled sac that 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. Here, the bursa is between the ischial tuberosity at the pelvis base and the hamstring tendon.  

 

 

 

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 an aggravated condition. An infection causing ischiogluteal bursitis can ultimately lead to 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. For example, an injury may occur as a result of 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 that 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. Crystal deposits also cause gout, which shares many similar symptoms with bursitis.  

 

Proximal Hamstring Injury

Hamstring injuries are several of the most common types among athletes. These make up for most days or even weeks missed each year among 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. For example, an injury may occur as a result of a fall. This type of injury accounts for under 10 percent of all hamstring injuries, along with other related 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, injuries can occur from activities like sprinting or hurdling; however, the athletes most commonly affected in this case are waterskiers who fall forward while keeping their knee extended. In elderly patients, proximal hamstring injuries can result from different types of trauma, such as slipping on a wet surface or inadvertently performing the “splits.” 

 

Proximal hamstring injuries could include complete tendon or incomplete/partial tears. Young patients frequently avulse or fracture the bone and tendon in the pelvis or ischium. In older patients, the tendon usually avulses or tears from the bone of the ischium ‘s attachment point. Occasionally, the tendon may tear in its midsubstance, leaving a stump of tendon still attached to the bone. People frequently refer to this type of injury as a partial tear. 

 

 

Adductor Injuries

Acute damage to the muscles of the groin is known as an adductor muscle strain. Although various muscles in the human body can be injured, the adductor longus, medius, magnus, and gracilis are some of the most well-known muscle groups to be affected by an injury. According to healthcare professionals, strains are muscle tears that 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 that 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 various 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.  

 

People frequently refer to this type of injury as a partial tear of the adductor tendons, adduction of the legs and of the injured leg. Pain can develop gradually or cause 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. Acute cases restrict exercises and physical activities due to the tendon’s inability to withstand repeated tensile loading.  

 

 

Many sports, including running, soccer, horse riding, gymnastics, and swimming, trigger the adductors. The repetitive movements and the continuous change of direction in physical activities activate the adductor tendon, which makes athletes more prone to developing 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 intensity, particularly if the training type changes significantly.  

 

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 weakness in the thoracic muscles or abdominals can also significantly contribute to the development of adductor tendinopathy. Other causes include a failure to properly warm up, inactivity, fatigue, obesity, age-related weaknesses, genetics, or degeneration.  

 

Spinal Tumors

Other health issues typically cause back pain. 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 that 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. Acute cases restrict exercises and physical activities due to the tendon’s inability to withstand repeated tensile loading. The spinal tumor irritates the sciatic nerve. Furthermore, the following symptoms below may ultimately be commonly associated with a spinal tumor, including 

 

• Symptoms may include neck pain or back pain, which can be followed by neurological health issues such as tingling sensations, weakness, and numbness in both the upper and lower extremities, along with abnormal bladder and bowel habits.
• Painful symptoms, particularly in the morning
• Severe pain with manipulation of the affected region of the spine
• training intensity, particularly if the training type changes significantly
• Other health issues typically cause back pain. These symptoms may include 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 

 

• Other symptoms that may accompany back pain include appetite loss, which is more likely to occur 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 of sciatica with various other health issues. Accurate diagnosis and proper treatment are important for sciatic nerve pain management. We focus our information on chiropractic, musculoskeletal, and nervous health issues, along with 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  

 

 

 

 

XXYMOGEN’s exclusive professional formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly, Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call the office so that we can assign a doctor for your consultation and provide immediate access.

 

If you are a patient of Injury Medical & Chiropractic Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

 

 

 

For your convenience and review of the XYMOGEN products, please review the link: *XYMOGEN-Catalog-Download

 

 

 

 

 

XXYMOGEN’s exclusive professional formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly, Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call the office so that we can assign a doctor for your consultation and provide immediate access.

 

If you are a patient of Injury Medical & Chiropractic Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

 

 

 

For your convenience and review of the XYMOGEN products, please review the link: *XYMOGEN-Catalog-Download

 

 

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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 is 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 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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Formulas for Methylation Support

 

 

 

 

XXYMOGEN’s exclusive professional formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly, Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call the office so that we can assign a doctor for your consultation and provide immediate access.

 

If you are a patient of Injury Medical & Chiropractic Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

 

 

 

For your convenience and review of the XYMOGEN products, please review the link: *XYMOGEN-Catalog-Download