Is it sciatica?
Typical sciatica follows a dermatomal pattern down the leg, may be worse with coughing, sneezing or sitting, and can be accompanied by tingling or numbness. Hip or knee pain, cramps and widespread aching have other causes.
The neurological examination tests power, sensation, reflexes and straight-leg raise. A clear nerve-root pattern is more convincing than pain location alone.
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When imaging and nerve tests are needed
Most episodes improve without urgent imaging. MRI is considered when weakness is progressive, symptoms persist despite treatment, surgery is being considered, or another cause such as infection or tumour is suspected.
EMG and nerve conduction studies can help when the diagnosis is unclear, when multiple levels are involved, or when neuropathy rather than radiculopathy is suspected.
- Progressive weakness or foot drop
- Bladder or bowel dysfunction (emergency)
- Fever, cancer history or unexplained weight loss
- Persistent symptoms despite conservative care
Treatment and recovery
Most patients improve with activity modification, short-term analgesia, physiotherapy and attention to posture and lifting. Medicines are chosen according to pain type, other medical conditions and interaction risk.
Urgent surgical referral is needed for cauda equina syndrome or progressive significant weakness. Otherwise, the decision about surgery is made with the patient, the neurologist and a spinal surgeon after imaging and response to conservative care.
Access and booking
Appointments are at Kathmandu Neurology Clinic & Cognitive Center, 117 Lal Durbar Marg, Kathmandu, opposite Yak & Yeti Hotel. Call +977-9747736624 or use /book-appointment. Bring prior reports, imaging and a medication list.