S

sciatica Irritation and INFLAMMATIONof the sciatic
NERVE, which runs from the lumbar spine (low
back) down the buttock and into the leg. Sciatica
is a type of peripheral NEUROPATHYthat is often a
chronic condition. Injuries to the hip and pelvis
may involve the sciatic nerve. However, often
there is no identifiable cause for sciatica.
The main symptom of sciatica is a shooting or
searing PAINthat extends through the buttock and
into the leg. Sciatica usually involves only one
side of the body though sometimes symptoms
are bilateral (involve both sides), depending on
the cause. Typically no particular incident sets
off the pain; it just occurs and may be severe. Sci-
atica may also interfere with foot placement or
walking.
The diagnostic path begins with a NEUROLOGIC
EXAMINATIONthat focuses on the lower body. In sci-
atica the reflexes at the knee and heel (ACHILLES
TENDON REFLEX) are often slow or absent. Diagnos-
tic procedures such as electromyogram (EMG) and
nerve conduction studies typically produce abnor-
mal results as well. Treatment targets the cause of
the sciatica when known and symptoms other-
wise. Medications such as NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS (NSAIDS) can relieve
inflammation and pain, though people who have
severe pain may need prescriptionANALGESIC MED-
ICATIONS for pain relief. Exercises and physical
activity to strengthen muscles and improve FLEXI-
BILITYare helpful when the inflammation subsides.
Most sciatica is a long-term, chronic condition that
comes and goes. Specific movements or activities
may trigger pain in some people, and in other
people the pain appears without apparent provo-
cation.
See also DIABETES; HERNIATED NUCLEUS PULPOSUS;
SPINAL NERVES; SPINAL STENOSIS.

scoliosis An abnormal curvature that takes the

spine to the side. The healthy spine does not curve

to the side. Scoliosis is idiopathic—that is, doctors

do not know what causes it. Treatment to

straighten the spine in childhood is important

because the curvature is likely to become more

extreme in adulthood and can interfere with vari-

ous functions, including BREATHING. Scoliosis

screening among children in the public schools is

common in the United States. Adult-onset scolio-

sis, though uncommon, may occur with OSTEO-

POROSIS, RHEUMATOID ARTHRITIS, and other

inflammatory conditions that affect the spine.

Symptoms and Diagnostic Path

The distinguishing symptom of scoliosis is an S-

shaped curvature seen in the spine from behind.

Subtle symptoms of scoliosis that can help detect

the condition before the curvature becomes pro-

nounced include

• shoulders or hips that are noticeably uneven in
  height


• the tendency to lean to one side


• the appearance of a twisted or uneven waist


• shoulder blades that protrude prominently from
  the upper back


• complaints of backache or shoulder discomfort

The diagnosis of scoliosis is generally clear from

physical examination, though the doctor may con-

duct X-RAYstudies of the back to confirm it.

Treatment Options and Outlook

Treatment for scoliosis includes exercises to stretch

and strengthen the structures of the back and

often a brace that holds the spine in a more erect

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