, septic gluteal bursitis Straight leg raising and hip flexion both vary painfut (In. sciaica due to dsc lesion nip flexlon is not imited 8 Arthritöis

, septic gluteal bursitis Straight leg raising and hip flexion both vary painfut (In. sciaica due to dsc lesion nip flexlon is not imited 8 Arthritöis of the hip - Hip movements restricted and pain provokad by passive movemenis Radiograph of pelvis diagnostic 9 Intermittent claudiction when intemal iliac artery is aiiected alone. claudicaiton in gluteus maximus on walking may be the onry Symptom Dlagnostic aigns • Patient fies prone and his hip is axtended pasaively; this cauaes no pain He is then asked to keep the leg extended for a minute, this brings on the claudication spinal claudicatian - Pins and needes in both lower limbs on walking acrtain distance All arteries öf the lower limba patent on examination Causa is intraspinal ischemia of the nerve-rootscompressrd by a disc lesion or involved in arachnoiditis 10 Dissecting aneurysm- Arare cause of sciatica is lowly expanding aneürysm at the bifurcation öf aorta compressing 3rd and 4th LNS causing local pain and accompanied by pafaesthesia and weakness in left lower limb Severe baskache Aortography dagnostic Management - A SYMPTOMATIC SCIATICA -1 Acute stuge - (i) Rest in bed with boards under the mattress to support the back (ii) Analgesics äs requitred (iii) Hear (iv) Injection öf 2% procalne or öf lignocaine inlo the sciatic nerve or epidural space or tender spots in the sacro-iliac region may give dramatic relief 2 Chronic stage • Management will depend on cause Conser vative managemeni - (a) High sciailca - (i) lnjecton öf lender spots with 5% procaine (11) Countar-imttion, heat and massage (iii) Epidural Injection - 10 ml. öf 2% novocaine, followed by 80 to 100 ml of normal salina, repeated once a week Many patients with sciatlca due to extradural adheslons may be banefited by injeclon öf 30ml 1% procaine hydrochlonde mixed with 125 mg hydrocortisone injected into the epidural spaca Three injections are given on consecutive or altemate days This shoüld be followed by active and passive exercises carr'ed out to limit of foierance (b) Low aciatica - Stretching of sciatic nerve, and injection of novocaine inlo, or as near äs possible ro the sheath of the nerve B. SCIATICA DUE TO HERNIATED INTERVERTEBRAL DISC - 1. Conservative ireatment - Complete rest in bed in supine
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