The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome.

Abstract:

OBJECTIVE:To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS). DESIGN:Prospective constructive cohort study using sacroiliac joint block (SIJB) as the diagnostic gold standard. SETTING:Tertiary care center. PATIENTS:Consecutive patients describing low back pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ipsilateral sacral sulcus. INTERVENTIONS:All subjects underwent fluoroscopically guided SIJB. MAIN OUTCOME MEASURES:Response to SIJB was assessed with visual analog scale (VAS) ratings before and after the block. A reduction of the VAS rating by at least 80% was considered a positive response to SIJB. RESULTS:Fifty consecutive patients met our criteria and underwent SIJB. Thirty patients had positive response to SIJB, making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determining the presence of SIJS is therefore 60%. CONCLUSIONS:Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.

journal_name

Arch Phys Med Rehabil

authors

Slipman CW,Sterenfeld EB,Chou LH,Herzog R,Vresilovic E

doi

10.1016/s0003-9993(98)90008-9

subject

Has Abstract

pub_date

1998-03-01 00:00:00

pages

288-92

issue

3

eissn

0003-9993

issn

1532-821X

pii

S0003-9993(98)90008-9

journal_volume

79

pub_type

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