Encyclopedia of Health and Medicine

S
sciatica Irritation and INFLAMMATION of the sciatic
NERVE, which runs from the lumbar spine (low
back) down the buttock and into the leg. Sciatica
is a type of peripheral NEUROPATHY that is often a
chronic condition. Injuries to the hip and pelvis
may involve the sciatic nerve. However, often
there is no identifiable cause for sciatica.
The main symptom of sciatica is a shooting or
searing PAIN that extends through the buttock and
into the leg. Sciatica usually involves only one
side of the body though sometimes symptoms
are bilateral (involve both sides), depending on
the cause. Typically no particular incident sets
off the pain; it just occurs and may be severe. Sciatica
may also interfere with foot placement or
walking.
The diagnostic path begins with a NEUROLOGIC
EXAMINATION that focuses on the lower body. In sciatica
the reflexes at the knee and heel (ACHILLES
TENDON REFLEX) are often slow or absent. Diagnostic
procedures such as electromyogram (EMG) and
nerve conduction studies typically produce abnormal
results as well. Treatment targets the cause of
the sciatica when known and symptoms otherwise.
Medications such as NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS (NSAIDS) can relieve
inflammation and pain, though people who have
severe pain may need prescription ANALGESIC MED-
ICATIONS for pain relief. Exercises and physical
activity to strengthen muscles and improve FLEXI-
BILITY are helpful when the inflammation subsides.
Most sciatica is a long-term, chronic condition that
comes and goes. Specific movements or activities
may trigger pain in some people, and in other
people the pain appears without apparent provocation.
See also DIABETES; HERNIATED NUCLEUS PULPOSUS;
SPINAL NERVES; SPINAL STENOSIS.
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scoliosis An abnormal curvature that takes the
spine to the side. The healthy spine does not curve
to the side. Scoliosis is idiopathic—that is, doctors
do not know what causes it. Treatment to
straighten the spine in childhood is important
because the curvature is likely to become more
extreme in adulthood and can interfere with various
functions, including BREATHING. Scoliosis
screening among children in the public schools is
common in the United States. Adult-onset scoliosis,
though uncommon, may occur with OSTEO-
POROSIS, RHEUMATOID ARTHRITIS, and other
inflammatory conditions that affect the spine.
Symptoms and Diagnostic Path
The distinguishing symptom of scoliosis is an S-
shaped curvature seen in the spine from behind.
Subtle symptoms of scoliosis that can help detect
the condition before the curvature becomes pronounced
include
• shoulders or hips that are noticeably uneven in
height
• the tendency to lean to one side
• the appearance of a twisted or uneven waist
• shoulder blades that protrude prominently from
the upper back
• complaints of backache or shoulder discomfort
The diagnosis of scoliosis is generally clear from
physical examination, though the doctor may conduct
X-RAY studies of the back to confirm it.
Treatment Options and Outlook
Treatment for scoliosis includes exercises to stretch
and strengthen the structures of the back and
often a brace that holds the spine in a more erect