Sciatic Nerve Palsy 355.02

synonyms:

Sciatic Nerve Palsy ICD-9

• 355.0 (Lesion of sciatic nerve)
• 956.0 (Injury to peripheral nerve; sciatic nerve)

Sciatic Nerve Palsy Etiology / Epidemiology / Natural History

• May be do to: laceration, ischemia, compression (hematoma), distraction(leg lengthening in THA)
• Associated with posterior hip dislocation, acetabular fracture, THA.

Sciatic Nerve Palsy Anatomy

• Typically peroneal nerve is affect more than the tibial nerve.
• Motor fibers are typically affected to a greater extent than sensory fibers.

Sciatic Nerve Palsy Clinical Evaluation

• Late onset or late progression of a neurological deficit associated with evidence of local hematoma about the hip is indicative of hematoma causing the nerve palsy.
• Document neuro exam including muscle strength exam.

Sciatic Nerve Palsy Xray / Diagnositc Tests

• May consider CT scan to localize post-operative hematomas
• EMG/NCV may be helpful 4-6 weeks after initial diagnosis to monitor nerve function for recovery.

Sciatic Nerve Palsy Classification / Treatment

• After hip surgery: low-back, buttock pain, ecchymosis, thigh swelling, any neural deficit in the sciatic distribution is consistent with hematoma formation. Antiocoagulation reversal and prompt surgical decompression is the most effective way to minimize the neural deficit. (Flemin RE, JBJS 1979;61:37).
• Hematoma: decompression of the hematoma is indicated. Surgical decompression reduces the risk of long-term neurological sequelae.
• Immediate postoperative nerve palsy: exploration of the nerve is only indicated if there is reason to believe that a major direct injury (complete transection or encirclement of the nerve with cerclage wires) has occurred.
• Any paitent with a foot drop should be placed in an AFO.

Sciatic Nerve Palsy Associated Injuries / Differential Diagnosis

• Posterior Hip dislocation
• THA
• Acetabular Fracture

Sciatic Nerve Palsy Complications

• Equinus contracture (avoid by placing in AFO)
• Persistent motor or sensory deficit.

Sciatic Nerve Palsy Follow-up Care

• Neurological recovery is variable and is related to the severity of the initial injury.

Sciatic Nerve Palsy Review References

• Lewallen DG, JBJS, 1997;79A:1870
• (Flemin RE, JBJS 1979;61:37)
• Schmalzried TP, JBJS 1991;73:1074