Case

A patient presents to their physiatrist with pain to their buttocks as well as radiating down the posterior side of their right thigh, leg and foot. They also report locomotive issues with tripping over their right foot multiple times during the day. Physical examination shows weakness of dorsiflexion of the right foot.

Question 1/3 - What would be on your differential diagnosis?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

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Correct! What the case describes is a classical presentation of sciatica with pain radiating down the posterior lower extremity along the distribution of the sciatic nerve and lower limb motor weakness.

A posterolateral intervertebral disk herniation (a paracentral radiculiopathy) could be compressing the nerve roots contributing to the sciatic nerve (e.g. L4 or L5 are common locations for a disk herniation to occur)

Incorrect. A median radiculopathy would cause a cauda equina syndrome. Symptoms of that are more midline, revolving around 'saddle anesthesia' affecting thighs, buttocks, genital, and anal region sensory-motor function. A unilateral right leg pain isn't insistent with a median radiculopathy.

Correct! What the case describes is a classical presentation of sciatica with pain radiating down the posterior lower extremity along the distribution of the sciatic nerve and lower limb motor weakness.

The sciatic nerve emerges below the piriformis muscle, and in a piriformis syndrome inflammation or enlargement of that muscle causes compression on the adjacent sciatic nerve causing sciatica syndromes.

Incorrect. This syndrome is a stress injury from over use repetitive motions of the knee (running/cycling for example) and manifests as pain on the lateral aspect of the knee. This is not consistent with posterior pain from gluteal to foot.

Incorrect. Compartments within the lower limb are in thigh (anterior, posterior, medial) and leg (anterior, lateral, superficial posterior and superficial deep). To account for the described pain and motor weakness, the patient would need to have compartment syndromes in multiple regions (e.g. posterior thigh, posterior leg, etc) which is unlikely.

Incorrect. Trochanteric bursitis is an inflammation of the bursa between the gluteus maximus muscle and the greater trochanter of the femur. This manifests as pain at the lateral hip in the area of the bursa, but pain does not radiate to the posterior aspect or to the leg making the condition inconsistent with the symptoms described.