Ass hurts, thighs and calves are uncomfortable.

Hello, how long did you say you would sit? What do you do? Look at the symptoms you describe, such as sciatic nerve, or simple lumbar disc herniation.

If you're not hurt. Now I'll tell you something about sciatica, as follows.

Sitting on bones and meridians hurts.

It refers to sciatic neuropathy, which is a group of pain symptoms along the sciatic nerve pathway, that is, waist, buttocks, posterior thigh, posterolateral calf and lateral foot.

[etiology]

The sciatic nerve consists of lumbar 5 ~ sacral 3 nerve roots. According to the lesion site, sciatica can be divided into two types: root sciatica and dry sciatica. The former is mostly located in the spinal canal, and the most common cause is lumbar disc herniation, followed by intraspinal tumor, lumbar tuberculosis and lumbosacral radiculitis. The pathological changes of sciatica sicca mainly occur in the process of sciatica outside the spinal canal. Etiology includes sacroiliitis, pelvic tumor, uterine compression during pregnancy, hip trauma, piriformis syndrome, improper gluteal muscle injection, diabetes and so on.

[Clinical manifestations]

This disease is more common in young men and occurs unilaterally. The degree and time of pain are often related to the etiology and the urgency of the disease.

First of all, the incidence of radicular sciatica is different due to illness.

The most common lumbar disc herniation is often induced by exertion, bending or strenuous activity, causing acute or subacute attacks. A few patients have chronic attacks. Pain often radiates from the waist to one hip, the back of thigh, popliteal fossa, the outside of calf and foot, showing burning pain or knife pain, which can be aggravated when coughing or exerting force, especially at night. In order to avoid nerve traction and compression, patients often take special pain-reducing postures, such as lying on the healthy side when sleeping, bending the hips and knees, and focusing on the healthy side when standing, which will cause scoliosis, bending to the healthy side for a long time, and leaning to the healthy side when sitting, so as to reduce the compression of nerve roots. Stretching the sciatic nerve can induce pain or aggravate it, such as Kernig sign positive (patients lie on their backs, bend their hips and knees at right angles first, and then lift their calves. Due to flexor spasm, knee extension is limited to less than 130 degrees with pain and resistance); Straight leg elevation test (Lasegue sign) is positive (the patient lies on his back, his lower limbs are extended, and the affected limb cannot be elevated at 70 degrees, causing leg pain). The sciatic nerve pathway may have tenderness, such as waist point, buttock point, country point, ankle point and plantar point. The lateral leg and instep of the affected limb often have numbness and hypoesthesia. The gluteal muscles are tense and relaxed, and the thumb extension and flexion muscles are weakened. Achilles tendon reflex weakened or disappeared.

Second, dry sciatica:

The order of onset is also different due to illness. For example, those induced by cold or trauma have more acute attacks. Pain often radiates from the buttocks to the back of the thigh, the back of the calf and the outside of the foot. The pain is aggravated when walking, moving and pulling the sciatic nerve. The tenderness point is below the hip point, Lasegue sign is positive, Kernig sign is mostly negative, scoliosis bends to the affected side, which reduces the traction on the sciatic nerve trunk.

[Diagnosis and differential diagnosis]

It is not difficult to diagnose pain according to the location and radiation direction of pain, factors aggravating pain, posture relieving pain, traction pain and tenderness point, but it is very important to determine the cause.

1. Lumbar disc herniation: Patients often have a long history of repeated low back pain or heavy physical labor, and acute diseases often occur after waist injury or bending over. In addition to the typical symptoms and signs of radicular sciatica, there are lumbar muscle spasms, limited lumbar movement and loss of flexion, and the prominent intervertebral disc space may have obvious tenderness and radiation pain. X-ray film can narrow the involved intervertebral space, and CT examination can confirm the diagnosis.

Second, cauda equina tumor: the onset is slow and gradually aggravated. The onset is usually unilateral radicular sciatica, which gradually develops into bilateral sciatica. The pain at night is obviously aggravated, and the course of disease is gradually aggravated. Sphincter dysfunction and sellar hypoesthesia occurred. Lumbar puncture shows subarachnoid obstruction, the protein content of cerebrospinal fluid is obviously increased, and even Froin sign (yellow cerebrospinal fluid, self-coagulation after placement) can be diagnosed by myelography or MRI.

Third, lumbar spinal stenosis: it is more common in middle-aged men, and "intermittent claudication" often occurs in the early stage. After walking, the pain in the lower limbs is aggravated, but the symptoms are relieved or disappeared after bending over to walk or rest. When nerve roots or cauda equina are severely compressed, symptoms and signs of unilateral or bilateral sciatica can also appear, and the course of disease is gradually aggravated, so bed rest or traction is ineffective. X-ray or CT of lumbosacral vertebra can be diagnosed.

Lumbosacral radiculitis: due to infection, poisoning, nutritional metabolism disorder or strain, cold and other factors. Generally, the onset is more urgent, and the damage range often exceeds the control area of sciatic nerve, which is characterized by weakness, pain and mild muscle atrophy of the whole lower limb. Except Achilles tendon reflex, knee tendon reflex often weakens or disappears.

In addition, it is also necessary to consider lumbar tuberculosis, spinal metastatic cancer and so on. In the case of dry sciatica, we should pay attention to whether there is a history of cold or infection, as well as the lesions of sacroiliac joint, hip joint, pelvis and buttocks. When necessary, besides X-ray examination of lumbosacral region, X-ray examination of sacroiliac joint and anal finger, gynecological examination and B-ultrasound examination of pelvic organs can be performed to clarify the cause.

[therapy]

First, bed rest: especially in the early stage of disc herniation, rest on a hard bed for 3-4 weeks, and some patients' symptoms will relieve themselves.

Second, drug treatment: painkillers, vitamin B family and short-term corticosteroids can be beneficial to recovery.

Third, physical therapy: ultrashort wave therapy, erythema dose ultraviolet radiation and other treatments can be used in the acute stage. In the chronic stage, direct current iodine ions can be introduced by short wave therapy.