The Value of Medical History and Physical Examination in Diagnosing Sacroiliac Joint Pain

Dreyfuss, Paul; Michaelsen, Mark; Pauza, Kevin; McLarty, Jerry; Bogduk, Nikolai

doi:10.1097/00007632-199611150-00009

Cited by 495 publications

(316 citation statements)

References 19 publications

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“…In the study of Dreyfuss et al [4], concerning the value of physical tests to non-pregnant persons with intra-articular sacroiliac joint pain origin, they found poor association between the clinical tests and pain relief by intra-articular injections. Of the 12 tests used, however, a combination of sacal sulcus tenderness and pointing to the spinae ileac posterior superior (SIPS) had the best predictive value.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Albert

Godskesen

Westergaard

2000

European Spine Journal

173

145

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IntroductionPelvic joint pain and low back pain must be considered a major problem for pregnant women, with reported incidences varying from 4 to 78% [1,7,13,14]. The disparity between these figures suggests the need for consistent classification criteria. It also suggests a certain level of diagnostic confusion, which increases the likelihood of inappropriate treatment.Previous investigations, as well as clinical experience, reveal that symptom complexes in those suffering pain from the pelvic joints differ sharply from symptom complexes related to pain coming from the lower back [5,14,16,19]. The therapy differs too [7,8,19].Abstract Pain in the pelvic joints and lower back, a major problem for pregnant women, has proved resistant to precise measurement and quantification. To develop a classification system, the clinical tests used must be able to separate pelvic from low back pain; they must also have a high inter-examiner reliability, sensitivity and specificity, and preferably be easy to perform. The aim of this study was to describe a standardised way of performing tests for examining the pelvis, and to evaluate interexaminer reliability, and establish the sensitivity and specificity of 15 clinical tests. It was designed as a longitudinal, prospective, epidemiological cohort study. First, 34 pregnant women were examined by blinded examiners to establish inter-examiner reliability. Second, a cohort of 2269 consecutive pregnant women, each responded to a questionnaire and underwent a thorough and highly standardised physical examination (15 tests with 48 possible responses) of the pelvic joints and surrounding areas. The 535 women who reported daily pain from the pelvic joints and had objective findings from the joints were divided, according to symptoms, into four classification groups and one miscellaneous group. The results of the study showed inter-examiner agreement of the tests was high, calculated in percentage terms, at between 88 and 100%. Using the Kappa coefficient, most tests kept the high agreement: six tests had an inter-examiner agreement of between 0.81 and 1.00, three between 0.61 and 0.80, and two between 0.60 and 0.41. Five tests showed superior sensitivity. The specificity of the tests was between 0.98 and 1.00, except the value for pelvic topography, which was 0.79. These results show that it is possible to standardise examination and interpretation of clinical tests of the pelvic joints, resulting in a high degree of sensitivity, specificity and inter-examiner reliability.

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Section: Discussionmentioning

confidence: 99%

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Albert

Godskesen

Westergaard

2000

European Spine Journal

173

145

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“…Dreyfuss et al [39] reported that only 4 % of patients with SIJ pain marked any pain above L5 on selfreported pain drawings. Referral of pain into various locations of the lower extremity does not distinguish SIJ pain from other pain states.…”

Section: Clinical Features and Pain Patternsmentioning

confidence: 99%

“…Previous studies have reported that there is no one single specific physical examination that can accurately identify a painful SIJ [38,39,42,47]. Dreyfuss et al [39,48] found that 20 % of asymptomatic adults had positive findings on three commonly performed SIJ provocation tests and that the test with the highest sensitivity was the test of sacral sulcus tenderness (89 %), although this test exhibited poor specificity.…”

Section: Physical Examinationsmentioning

confidence: 99%

“…Dreyfuss et al [39,48] found that 20 % of asymptomatic adults had positive findings on three commonly performed SIJ provocation tests and that the test with the highest sensitivity was the test of sacral sulcus tenderness (89 %), although this test exhibited poor specificity. Slipman et al [47] reported a positive-predictive value of 60 % in diagnosing SIJ pain in patients using a positive response to three SIJ provocation tests.…”

Section: Physical Examinationsmentioning

confidence: 99%

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Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge

Yoshihara

2012

Eur Spine J

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Recently, the sacroiliac joint (SIJ) has gained increased attention as a source of persistent or new pain after lumbar/lumbosacral fusion. The underlying pathophysiology of SIJ pain may be increased mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. Imaging studies show more frequent degeneration of the SIJ in patients with lumbar/lumbosacral fusion than in patients without such fusion. Using injection tests, it has been shown that SIJ pain is the cause of persistent symptoms in a considerable number of patients after fusion surgery. Recent articles reporting on surgical outcomes of SIJ fusion include a high percentage of patients who had lumbar/lumbosacral fusion or surgery before, although well-controlled clinical studies are necessary to assess the efficacy of surgical treatment. Taking these findings into consideration, the possibility that the SIJ is the source of pain should be considered in patients with failed back surgery syndrome after lumbar/lumbosacral fusion.

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“…More specialised tests for localised tension and reduced mobility have not been similarly successful [3,4,16] although the results may improve with specialisation of the examiners [17,20]. Very few results have been presented to support the possibility of an exact clinical diagnosis of a more specific pathology in the low back [21].…”

Section: Introductionmentioning

confidence: 99%

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

et al. 2006

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Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc).

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The Value of Medical History and Physical Examination in Diagnosing Sacroiliac Joint Pain

Abstract: Sacroiliac joint pain is resistant to identification by the historical and physical examination data from tests evaluated in this study.

Cited by 495 publications

References 19 publications

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

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