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Tests and diagnosis

By Mayo Clinic staff

To help diagnose sciatica and pinpoint which nerves, if any, are affected, your doctor will use these approaches:

  • Medical history. Your doctor will ask about your medical history.
  • Physical exam. Your doctor will perform a thorough physical exam, paying special attention to your spine and legs.
  • Basic muscle tests. Likely, your doctor will have you undergo some basic tests that check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time straight in the air. Pain that results from sciatica will usually become worse during these activities.

Imaging tests
If your pain lasts longer than four weeks or is very severe, or you have another serious condition such as cancer, you may have one or more imaging tests to help identity why the sciatic nerve is compressed and to rule out other causes for your symptoms.

These tests include:

  • Spinal X-ray. Ordinary X-rays can't detect herniated disk problems or nerve damage. A spinal X-ray can help pinpoint the cause of sciatica.
  • Magnetic resonance imaging (MRI). This is probably the most sensitive test for assessing sciatic nerve pain. Instead of X-rays, MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. Most MRI machines are large, tube-shaped magnets. During the test, you lie on a movable table inside the MRI machine.
  • Computerized tomography (CT) scan. This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body. When CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
Treatments and drugs Preparing for your appointment
References
  1. Lin M. Musculoskeletal back pain. In: Marx JA, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2006. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-323-05472-0..00051-7--s0045&displayedEid=4-u1.0-B978-0-323-05472-0..00051-7--s0060&uniq=184337872&isbn=978-0-323-05472-0&sid=955285604. Accessed March 1, 2010.
  2. Rosenbaum RB, et al. Degenerative disease of the spine. In: Bradley WG. Neurology in Clinical Practice. 5th ed. Burlington, MA: Butterworth-Heinemann; 2008. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-7506-7525-3..50115-1--cesec38&displayedEid=4-u1.0-B978-0-7506-7525-3..50115-1--cesec55&uniq=184337872&isbn=978-0-7506-7525-3&sid=955285604. Accessed March 1, 2010.
  3. Gregory DS, et al. Acute lumbar disk pain: Navigating evaluation and treatment choices. American Family Physician. 2008;78:835.
  4. Aminoff MJ. Mechanical and other lesions of the spine, nerve roots, and spinal cord. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/184337872-18/0/1492/1420.html#4-u1.0-B978-1-4160-2805-5..50428-6--cesec37_17875. Accessed March 1, 2010.
  5. Devereaux M. Low back pain. Medical Clinics of North America. 2009;93:477.
  6. Low back pain fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#119483102. Accessed March 1, 2010.
  7. Wheeler SG, et al. Approach to the diagnosis and evaluation of low back pain in adults. http://www.uptodate.com/home/index.html. Accessed March 1, 2010.
  8. Knight CL, et al. Treatment of acute low back pain. http://www.uptodate.com/home/index.html. Accessed March 1, 2010.
  9. Ernst E. Complementary treatments in rheumatic diseases. Rheumatic Disease Clinics of North America. 2008;34:455.
  10. Chronic pain: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm. Accessed March 1, 2010.
  11. Laskowski ER (expert opinion). Mayo Clinic, Rochester, Minn. March 4, 2010.
DS00516 April 22, 2010

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