Symptoms
An S1 syndrome causes characteristic symptoms, such as pain, sensory disturbances and paralysis, in the area supplied by the S1 nerve root. A major symptom is pain. These can run from the lower back and buttocks to the back of the upper and lower leg, and can affect the lateral edge of the foot and the little toe.
The pain is often described as suddenly shooting up and occurs in many patients depending on the load. In addition, sensations such as tingling, formication or numbness can often be observed in this area. In addition, the calf muscles (Musculus triceps surae), the posterior thigh muscle (Musculus biceps femoris) and the foot sinks can be paralyzed.
This manifests itself in a weakness of the foot drop, as well as in an inability to stand or walk on the toes. Typically, the Achilles tendon reflex is extinguished because it is caused by a muscle twitch of the triceps surae muscle. S1 syndrome is often accompanied by pain that extends from the lower back and buttocks into the leg.
The pain is localized on the outside and back of the thigh and lower leg. They can extend from the lateral edge of the foot to the little toe. The pain is usually described as sudden shooting and occurs during physical exertion.
If there is permanent compression of the nerve root, for example in the context of a constricted neuroforamen or a tumor, the pain is usually permanent. The S1 nerve root supplies areas from the buttocks to the little toe and runs from the back of the lower leg via the heel to the lateral edge of the foot. The heel is therefore supplied by the S1 nerve root and can become symptomatic in S1 syndrome. Heel pain is a possible symptom in this disease.
Diagnosis
For the diagnosis of S1 syndrome, it is above all the precise questioning by the doctor and the physical examination that are decisive. The questions focus primarily on the exact classification of the pain and the questioning of further symptoms, previous stress, accidents and known illnesses. During the examination, the physician pays particular attention to abnormalities in the gait and still image and especially to the tiptoe gait.
Furthermore, he checks the sensitivity of the skin for reduction or if necessary.Miss sensations and tests the Achilles tendon reflex. Additional imaging can be used to detect and accurately assess a herniated disc. In principle, the body and especially the extremities have a very symmetrical structure.
This also applies to the spinal nerve roots, which exit the spinal cord on the same side and move to the right and left to their respective supply areas. However, the side comparison can be an important diagnostic criterion and provide further information about the exact localization and extent of the cause, especially of a herniated disc. If the symptoms occur on one side, only the nerve root on the same side is affected by the constriction or irritation.
The comparison with the side without symptoms can be used during the examination to determine the extent of the symptoms and to narrow them down more precisely. For example, are touches on both sides perceived equally or are the sensations in the affected side attenuated? If the symptoms occur equally in both extremities, the S1 syndrome is probably caused by a very pronounced large herniated disc or larger space-consuming processes such as tumors or edema.
The Lasègue sign is used to examine the nerve roots L4, L5, S1, S2 and S3 and the sciatic nerve. The sciatic nerve originates from the nerve roots L4 to S3. To perform the test, the patient lies in a supine position and the doctor bends the patient’s stretched leg in the hip.
This flexion stretches the sciatic nerve. A positive Lasègue sign is a pain that shoots before and/or during the test at about 70 to 80° of flexion. A positive Lasègue sign can be an indication of Further test: Bragard test
- A slipped disc of the lumbar spine
- An inflammation of the nerve root and/or
- A Meningitis
