Wallet Sciatica and more…
While I was going through chiropractic college, I heard of this truck driver case who developed sciatic pain because he drives long distance while sitting on his wallet. The wallet presses against the buttock where the sciatic nerve runs through. In addition, by sitting on one elevated hip, the stress of the lumbar discs on the nerve roots of sciatic nerves can further aggravate the condition. About a month ago, I encountered my first case of wallet sciatica.
Patient presented with right-sided sciatic pain only when he drives or sits for a long time. The first thing I noticed is that he has a huge wallet that he had to pull out from his right back pocket before physical examination.
In real life, signs and symptoms don’t exist perfectly like they do in textbooks. This patient not only has the right-sided sciatic pain, he also experienced a feeling of “heaviness” in both of his feet and hands. Naturally a wallet isn’t going to cause the symptoms in his hands and feet, so the investigation goes on…
The patient claims that he has full sensation but he feels decreased touch sensitivity. His sciatic pain is aggravated with driving but the bilateral foot and hands pain comes on without driving with no obvious pattern to the patient. Physical exam shows he displays no muscles weakness or balance problems in his gait. Neurological tests like deep tendon reflexes and Babinski reflex of the lower limbs were normal. He was unable to distinguish between sharp and dull sensation in certain areas of the feet and hands. Lastly, he is a chronic smoker and has been diagnosed with diabetes for more than 10 years.
Off the top of my head, some potential diagnosis that may explain his symptoms in both hands and feet include:
- cervical spinal stenosis
- peripheral arterial disease
- peripheral neuropathy
Let’s look at them one by one:
Cervical spinal stenosis (narrowing of the spinal canal in the neck) usually presents with numbness, weakness or tingling in legs, feet, arms or hands. Tingling in the hands is the most common symptom, and many people also report heavy feeling in the legs and problems with walking and balance.
The patient did present with “heaviness” in both feet but he did not have problem with walking and balancing, nor did his neurological tests suggest a stenosis since the Babinski response would have been abnormal and the lower limb deep tendon reflex would be accentuated (hyperreflexia). An MRI scan of his neck will be needed to confirm the diagnosis.
Peripheral arterial disease is a circulatory problem in which narrowed arteries reduce blood flow to your limbs, most notably in the legs. This causes muscle pain or cramping in your legs or arms that’s triggered by activity, such as walking, but disappears after a few minutes of rest. Although the patient did not have a clear pattern of pain with activity and relief by rest, he did present with coldness and paleness in both hands and feet and a weak pulse in bilateral foot, which is commonly observed in peripheral arterial disease. People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow. To get a more accurate study of the blood flow, we will require ultrasound imaging techniques or perform an angiography.
Peripheral neuropathy is resulted from damage to the peripheral nerves, often causes weakness, numbness and pain, usually in the hands and feet. One of the most common causes is diabetes mellitus since prolonged exposure to high blood sugar can damage delicate nerve fibers. A definitive diagnosis would require electromyography which records electrical activity in the muscles to detect nerve damage.
It is most likely that the patient either has an early stages of peripheral neuropathy or peripheral arterial disease. It is yet to be determined as I co-manage the case with his medical doctor. Either diagnosis would require the patient to quit smoking, start exercising, eating a healthy diet, and getting his blood sugar regulated, which is what I had suggested.
The good news is that the patient no longer has the sciatic pain after 3 weeks of chiropractic treatment and rehab exercises. The sad part is that the patient is still feeling the heaviness in both hands and feet and he has no intention of quitting smoking. When I first discussed his diagnosis and treatment option, the patient was agitated about how doctors blame everything onto his smoking and diabetes. The fact that they are risk factors for so many conditions because they affect your circulatory and nervous system that supplies literally everything in your body. I hope the patient would understand that I did not arrive at the differential diagnosis lightly.
As much as I wish I could wave a magic wand and get rid of the underlying culprit like moving the wallet, I couldn’t. And I really do hope one day I could inspire him to take charge of his health fully. Lastly, it goes without saying…if you’re still carrying your wallet, a cellphone, or anything firm in your back pocket while driving or sitting for a long time, don’t say I didn’t warn you ;)
Willow Glen Chiropractic
1314 Lincoln Ave Ste 2E
San Jose, CA 95125