Stiffness in the waist

Introduction Lumbar stiffness refers to the stiffness of the waist caused by diseases such as sciatica. It is one of the clinical symptoms of sciatica. Sciatica refers to sciatic neuropathy, a group of painful symptoms that occur along the sciatic nerve pathways, namely the lower back, buttocks, back of the thigh, posterior aspect of the lower leg, and lateral aspect of the foot. The sciatic nerve is the main nerve trunk that governs the lower extremities. Sciatica refers to pain in the sciatic nerve pathway and its distribution (hip, back of the thigh, posterior aspect of the calf, and lateral aspect of the foot).

Cause

Causes of lumbar stiffness:

The sciatic nerve is composed of the 5~3 nerve roots. According to the lesion site rooting and dry sciatica, the former more common root sciatica lesions located in the spinal canal, the most common cause of lumbar disc herniation, followed by intraspinal tumor, lumbar tuberculosis, lumbosacral radiculitis, etc. . The lesions of dry sciatica are mainly in the extraspinal sciatic nerve. The causes are sacral arthritis, pelvic tumor, uterine compression, hip trauma, piriformis syndrome, improper gluteal injection, and diabetes.

The cause of primary sciatica (sciatic neuritis) is unknown and clinically rare.

Secondary sciatica is caused by compression or stimulation of adjacent lesions, and is divided into root and dry sciatica, which refers to whether the compression site is in the nerve root or in the nerve trunk. The root is more common, the cause of the most common disc herniation, other causes of intraspinal tumor, vertebral body metastasis, lumbar tuberculosis, lumbar spinal stenosis, etc.; dry can be caused by ankle arthritis, pelvic tumor, pregnancy uterus compression, hip joint Inflammation, hip trauma, diabetes, etc.

an examination

Related inspection

Sitting body flexion test cremaster reflection

Examination and diagnosis of lumbar stiffness:

History and symptoms: Sciatic neuropathy is more common in middle-aged and older men, with more unilateral. Sudden onset, first felt lower back pain and waist stiffness. Or a few weeks before the onset, there is a short-term pain in the lower limbs while walking and exercising. It gradually increased and became severe pain. Pain begins at the waist, hips, or hips, and spreads down the back of the thigh, the outside of the calf, and the back of the foot. There is a burst of burning or acupuncture-like pain on the basis of persistent pain. It is more serious at night.

First, root sciatica: onset varies with the cause. The most common lumbar disc herniation, often caused by acute, subacute onset, such as exertion, bending or strenuous activity. A few are chronic onsets. Pain often radiates from the waist to one side of the buttocks, behind the thighs, to the outside of the nest, to the outside of the calf, and to the feet. It is a burning or knife-like pain. The pain can be aggravated by coughing and exertion, and even worse at night. In order to avoid nerve pulling and compression, the patient often takes special pain-reducing postures, such as lying to the healthy side during sleep, flexing the hips and knees, and focusing on the healthy side when standing, causing scoliosis and bending for a long time. On the side, the seat is tilted into the buttocks to the healthy side to reduce the pressure on the nerve roots. Pulling the sciatic nerve can induce pain, or the pain is aggravated, such as the Kernig sign positive (the patient is lying on his back, the hip and knee are at right angles, and then the calf is raised. Because of the flexor tendon, the knee extension is limited to less than 130 degrees and there is Pain and resistance); the straight leg raising test (Lasegue sign) is positive (the patient is lying on his back, the lower extremity is extended, and the affected limb is lifted less than 70 degrees to cause leg pain). The sciatic nerve pathway can have tenderness, such as waist point, hip point, country point, sputum point and sputum point. The outside of the calf and the back of the foot often have numbness and loss of sensation. The gluteal muscles are relaxed, and the thumb and flexor muscles are weakened. Achilles tendon reflexes weaken or disappear.

Second, dry sciatica: the onset of illness also varies with the cause. If the cold or trauma induced more acute onset. Pain often radiates from the buttocks to the back of the thigh, the posterior aspect of the calf, and the outside of the foot. Pain worsens when walking, moving, and pulling the sciatic nerve. The tenderness point is below the hip point, the Lasegue sign is positive and the Kernig sign is more negative, and the scoliosis is more bent to the affected side to reduce the pulling of the sciatic nerve trunk.

Physical examination found:

1. Tender point: There are tender points along the sciatic nerve distribution area such as waist, sputum, hip, sputum, and sputum.

2. Sciatic nerve: positive signs, such as Kernig sign, Laseque sign, Bonnet sign and other positive.

3. Within the scope of sciatic nerve innervation, there are varying degrees of movement, sensation, reflex and autonomic dysfunction. The dorsiflexion of the affected side of the toes is weak, the pain of the skin on the outside of the calf is reduced, the Achilles tendon reflex disappears, and the hip muscle tension is lowered.

Differential diagnosis

Symptoms of complication of lumbar stiffness:

First, lumbar disc herniation: patients often have a longer history of repeated low back pain, or heavy physical labor history, often in a lumbar injury or bending after the acute incidence of labor. In addition to the symptoms and signs of typical root sciatica, there are lumbar muscle spasm, limited lumbar motion and loss of anterior lumbar flexion. The intervertebral space of the disc herniation may have obvious tenderness and radiation pain. X-ray film can have narrowed intervertebral space, and CT examination can confirm the diagnosis.

Second, the horsetail tumor: the onset is slow, gradually worsening. The disease is often unilateral root sciatica, gradually developed into bilateral. The pain at night is obviously aggravated, and the course of the disease is progressively worse. There are also sphincter dysfunction and sensory loss in the saddle area. Lumbar puncture has subarachnoid obstruction and cerebrospinal fluid protein quantitatively increased, and even Froin sign (cerebrospinal fluid yellow, self-coagulation after placement), spinal iodine angiography or MRI can be diagnosed.

Third, lumbar spinal stenosis: more common in middle-aged men, often in the early "intermittent claudication", lower limb pain after walking, but the symptoms are reduced or disappeared after walking or resting. When the nerve root or cauda equina is severely stressed, symptoms and signs of sciatica on one or both sides may be present, and the course of the disease is progressively aggravated. Treatment such as bed rest or traction is ineffective. Lumbar sacral X-ray or CT can be diagnosed.

Fourth, lumbosacral radiculitis: due to infection, poisoning, nutritional metabolic disorders or strain, suffering from cold and other factors. Generally, the onset is more urgent, and the damage range often exceeds the area of the sciatic nerve. The whole lower limb weakness, pain, mild muscle atrophy, and the Achilles tendon reflex are often weakened or disappeared.

In addition, it is also necessary to consider lumbar tuberculosis, vertebral metastases and the like. In the case of dry sciatica, attention should be paid to the history of cold or infection, as well as the ankle, hip, pelvis and buttocks. If necessary, in addition to lumbosacral X-ray, ankle X-ray can be performed. Photographs, anal fingers, gynecological examinations, and pelvic organs B-ultrasound were performed to determine the cause.

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