Diagram specific to sacroiliac joint pain site indicated by one-finger test

Murakami, Eiichi; Aizawa, Tadanori; Noguchi, Kyoko; Kanno, Haruo; Okuno, Hiroshi; Uozumi, Hiroaki

doi:10.1007/s00776-008-1280-0

Cited by 62 publications

(34 citation statements)

References 13 publications

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“…We found two additional studies investigating diagnostic value of SIJ area pointing, without indication of whether or not the pain was dominant, using insufficient reference standard in terms of a single or periarticular SIJ blocks [46, 149]. The results were not in concordance and warrant further investigation.…”

Section: Discussionmentioning

confidence: 99%

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

139

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BackgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.MethodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.ResultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.ConclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

139

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“…Other investigators have also found buttock pain extending into the posterolateral thigh to be the most typical referral pattern. Two studies found the SIJs to be the most likely source of pain when the worst area was located within 10 cm of the posterior superior iliac spine [37,38]. Slipman et al mapped out pain referral patterns by characterizing the distribution patterns in 50 patients who obtained ≥80% pain relief following single SIJ blocks: 94% reported buttock pain, 72% lumbar pain, 50% experienced pain extending into the lower extremity, 28% had pain below the knee, and groin pain was reported in 14% of individuals [39].…”

Section: Pain Patternsmentioning

confidence: 99%

Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment

Cohen

Chen

Neufeld

2013

Expert Review of Neurotherapeutics

327

236

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Sacroiliac joint (SIJ) pain is an underappreciated source of mechanical low back pain, affecting between 15 and 30% of individuals with chronic, nonradicular pain. Predisposing factors for SIJ pain include true and apparent leg length discrepancy, older age, inflammatory arthritis, previous spine surgery, pregnancy and trauma. Compared with facet-mediated and discogenic low back pain, individuals with SIJ pain are more likely to report a specific inciting event, and experience unilateral pain below L5. Owing in part to its size and heterogeneity, the pain referral patterns of the SIJ are extremely variable. Although no single physical examination or historical feature can reliably identify a painful SIJ, studies suggest that a battery of three or more provocation tests can predict response to diagnostic blocks. Evidence supports both intra- and extra-articular causes for SIJ pain, with clinical studies demonstrating intermediate-term benefit for both intra- and extra-articular steroid injections. In those who fail to experience sustained relief from SIJ injections, radiofrequency denervation may provide significant relief lasting up to 1 year. This review covers all aspects of SIJ pain, with the treatment section being primarily focused on procedural interventions.

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“…Fortin and Falco20 stated that SIJ patients could localize their pain with one finger and the area pointed to was within 1 cm inferomedial to the PSIS. Murakami et al24 observed positive effects from a periarticular SIJ block in 18 of 25 patients who located the primary site of their pain to within 2 cm of the PSIS. Murakami et al25 compared the effect of blocking injections into the intraarticular space and around the LPSL in patients fulfilling definite criteria for SIJ pain.…”

Section: Discussionmentioning

confidence: 99%

Anatomical study of middle cluneal nerve entrapment

Konno¹,

Aota²,

Saito³

et al. 2017

JPR

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ObjectEntrapment of the middle cluneal nerve (MCN) under the long posterior sacroiliac ligament (LPSL) is a possible, and underdiagnosed, cause of low-back and/or leg symptoms. To date, detailed anatomical studies of MCN entrapment are few. The purpose of this study was to ascertain, using cadavers, the relationship between the MCN and LPSL and to investigate MCN entrapment.MethodsA total of 30 hemipelves from 20 cadaveric donors (15 female, 5 male) designated for education or research, were studied by gross anatomical dissection. The age range of the donors at death was 71–101 years with a mean of 88 years. Branches of the MCN were identified under or over the gluteus maximus fascia caudal to the posterior superior iliac spine (PSIS) and traced laterally as far as their finest ramification. Special attention was paid to the relationship between the MCN and LPSL. The distance from the branch of the MCN to the PSIS and to the midline and the diameter of the MCN were measured.ResultsA total of 64 MCN branches were identified in the 30 hemipelves. Of 64 branches, 10 (16%) penetrated the LPSL. The average cephalocaudal distance from the PSIS to where the MCN penetrated the LPSL was 28.5±11.2 mm (9.1–53.7 mm). The distance from the midline was 36.0±6.4 mm (23.5–45.2 mm). The diameter of the MCN branch traversing the LPSL averaged 1.6±0.5 mm (0.5–3.1 mm). Four of the 10 branches penetrating the LPSL had obvious constriction under the ligament.ConclusionThis is the first anatomical study illustrating MCN entrapment. It is likely that MCN entrapment is not a rare clinical entity.

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Diagram specific to sacroiliac joint pain site indicated by one-finger test

Cited by 62 publications

References 13 publications

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment

Anatomical study of middle cluneal nerve entrapment

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