Sciatic Nerve Palsy S74.00XA 355.02

synonyms:

Sciatic Nerve Palsy ICD-10

• S74.00XA - Injury of sciatic nerve at hip and thigh level, unspecified leg, initial encounter
• S74.01XA - Injury of sciatic nerve at hip and thigh level, right leg, initial encounter
• S74.02XA - Injury of sciatic nerve at hip and thigh level, left leg, initial encounter
• See all Sciatic nerve ICD-10 codes.

A- initial encounter

D- subsequent encounter

S- sequela

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.
• Hip dysplasia and severe limb shortening are at high risk for sciatic nerve palsy following THAfrom over lengthening.

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: formed by the roots of the lumbosacral plexus
• Exits the pelvis through the greater sciatic notch and appears in the buttock anterior to the piriformus.
• Sciatic nerve passes posteriorly over the superior gemellus, obturator internus, inferior gemellus, and quadratus femoris before it passes deep to the biceps femoris. 

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).  Bedrest with the head of the bed level and the surgical knee flexed minimizes tension on sciatic nerve.
• 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
• Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res. 1987 May;(218):136-41.
• Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am. 2005 Dec;87(12):2619-25.