Editing Sciatica (section)

==Diagnosis==
[[File:Straight-leg-test.gif|thumb|''Straight leg'' test sometimes used to help diagnose a lumbar herniated disc]]
Sciatica is typically diagnosed by physical examination, and the history of the symptoms.<ref name=Valat2010/>

===Physical tests===
Generally, if a person reports the typical radiating pain in one leg, as well as one or more neurological indications of nerve root tension or neurological deficit, sciatica can be diagnosed.<ref name="pmid17585160" />

The most frequently used diagnostic test is the [[straight leg raise]] to produce [[Lasègue's sign]], which is considered positive if pain in the distribution of the sciatic nerve is reproduced with passive flexion of the straight leg between 30 and 70 degrees.<ref name="pmid15130982">{{cite journal | vauthors = Speed C | title = Low back pain | journal = BMJ | volume = 328 | issue = 7448 | pages = 1119–21 | date = May 2004 | pmid = 15130982 | pmc = 406328 | doi = 10.1136/bmj.328.7448.1119  }}</ref> While this test is positive in about 90% of people with sciatica, approximately 75% of people with a positive test do not have sciatica.<ref name=Valat2010/> Straight leg raising of the leg unaffected by sciatica may produce sciatica in the leg on the affected side; this is known as the Fajersztajn sign.<ref name=":2">{{Cite book |last1=Ropper |first1=Allan H. |last2=Samuels |first2= Martin A. |last3=Klein |first3=Joshua P. |year=2014 |chapter=Chapter 11. Pain in the Back, Neck, and Extremities |title=Adams and Victor's Principles of Neurology |url=https://accessmedicine.mhmedical.com/book.aspx?bookid=690 |edition=Tenth |location=New York |publisher=McGraw-Hill Education Medical |pages= |isbn=9780071794794 |oclc=857402060}}</ref> The presence of the Fajersztajn sign is a more specific finding for a herniated disc than Lasègue's sign.<ref name=":2" /> Maneuvers that increase intraspinal pressure, such as coughing, flexion of the neck, and bilateral compression of the [[jugular vein]]s, may transiently worsen sciatica pain.<ref name=":2" />

===Medical imaging===
Imaging modalities such as [[computerised tomography]] or magnetic resonance imaging can help with the diagnosis of lumbar disc herniation.<ref name="Gregory et al.">{{cite journal | vauthors = Gregory DS, Seto CK, Wortley GC, Shugart CM | title = Acute lumbar disk pain: navigating evaluation and treatment choices | journal = Am Fam Physician | volume = 78 | issue = 7 | pages = 835–42 | date = October 2008 | pmid = 18841731 }}</ref> Both are equally effective at diagnosing lumbar disk herniation, but computerized tomography has a higher radiation dose.<ref name="pmid17585160">{{cite journal | vauthors=Koes BM, vanTulder, HW, Peul WC | title = Diagnosis and treatment of sciatica | journal= [[The BMJ]] | volume=334 | issue=7607 | pages=1313 | year=2007 |  doi = 10.1136/bmj.39223.428495.BE | pmc=1895638 | pmid=17585160 }}</ref> [[Radiography]] is not recommended because disks cannot be visualized by [[X-ray]]s.<ref name="pmid17585160" /> The utility of [[Magnetic resonance neurography|MR neurography]] in the diagnosis of piriformis syndrome is controversial.<ref name=Miller2012/>

[[Lumbar provocative discography|Discography]] could be considered to determine a specific disc's role in an individual's pain.<ref name=":3" /> [[Lumbar provocative discography|Discography]] involves the insertion of a needle into a disc to determine the pressure of disc space.<ref name=":3" /> [[Radiocontrast agent|Radiocontrast]] is then injected into the disc space to assess for visual changes that may indicate an anatomic abnormality of the disc.<ref name=":3" /> The reproduction of an individual's pain during [[Lumbar provocative discography|discography]] is also diagnostic.<ref name=":3" />

===Differential diagnosis===
[[Cancer]] should be suspected if there is previous history of it, unexplained weight loss, or unremitting pain.<ref name=tarulli_radiculopathy/> Spinal [[epidural abscess]] is more common among those who have [[diabetes mellitus]] or [[immunodeficiency]], or who have had [[Vertebral column|spinal]] [[surgery]], [[Injection (medicine)|injection]] or [[catheter]]; it typically causes [[fever]], [[leukocytosis]] and increased [[erythrocyte sedimentation rate]].<ref name=tarulli_radiculopathy/> If cancer or spinal epidural abscess is suspected, urgent [[magnetic resonance imaging]] is recommended for confirmation.<ref name=tarulli_radiculopathy/> [[Proximal diabetic neuropathy]] typically affects middle aged and older people with well-controlled type-2 [[diabetes mellitus]]; onset is sudden, causing pain, usually in multiple [[Dermatome (anatomy)|dermatomes]], quickly followed by weakness. Diagnosis typically involves [[electromyography]] and [[lumbar puncture]].<ref name=tarulli_radiculopathy/> [[Shingles]] is more common among the elderly and immunocompromised; typically, pain is followed by the appearance of a [[rash]] with small blisters along a single [[Dermatome (anatomy)|dermatome]].<ref name=tarulli_radiculopathy/><ref name=Dwo2007>{{cite journal |vauthors=Dworkin RH, Johnson RW, Breuer J, etal | title=Recommendations for the management of herpes zoster| journal=[[Clin. Infect. Dis.]]| volume=44| pages=S1–26| year=2007| issue=Suppl 1| pmid=17143845| doi=10.1086/510206| s2cid=10894629| doi-access=free}}</ref> Acute [[Lyme radiculopathy]] may follow a history of outdoor activities during warmer months in likely tick habitats in the previous 1–12 weeks.<ref name=NEJM2014>{{cite journal | vauthors = Shapiro ED | title = Clinical practice. Lyme disease | journal = The New England Journal of Medicine | volume = 370 | issue = 18 | pages = 1724–1731 | date = May 2014 | pmid = 24785207 | pmc = 4487875 | doi = 10.1056/NEJMcp1314325 | url = http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-url = https://web.archive.org/web/20161019142422/http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-date = 19 October 2016 }}</ref> In the U.S., Lyme is most common in [[New England]] and [[Mid-Atlantic (United States)|Mid-Atlantic]] states and parts of [[Wisconsin]] and [[Minnesota]], but it is expanding to other areas.<ref name=CDC-Lyme-Data>{{cite web|title=Lyme Disease Data and surveillance | url=https://www.cdc.gov/lyme/datasurveillance/ | website=Lyme Disease|publisher=Centers for Disease Control and Prevention|access-date=April 12, 2019| date=2019-02-05 }}</ref><ref name=canada_lyme_map>{{cite web|title=Lyme Disease risk areas map | url = https://www.canada.ca/en/public-health/services/diseases/lyme-disease/risk-lyme-disease.html#map | website = Risk of Lyme disease to Canadians | publisher = Government of Canada | access-date = May 8, 2019| date = 2015-01-27 }}</ref> The first manifestation is usually an [[Erythema migrans|expanding rash]] possibly accompanied by flu-like symptoms.<ref name=ogrinc_bannwarth>{{cite journal | vauthors = Ogrinc K, Lusa L, Lotrič-Furlan S, Bogovič P, Stupica D, Cerar T, Ružić-Sabljić E, Strle F | title = Course and outcome of early European Lyme neuroborreliosis (Bannwarth syndrome): clinical and laboratory findings | journal = Clinical Infectious Diseases | volume = 63 | issue = 3 | pages = 346–53 | date = Aug 2016 | pmid = 27161773 | doi = 10.1093/cid/ciw299 | doi-access = free }}</ref> Lyme can also cause a milder, chronic radiculopathy an average of 8 months after the acute illness.<ref name=tarulli_radiculopathy/>