Sacroiliac Joint Assessment

[JayPhysio]

Hi all,

I was wondering what battery of tests people are using for the assessment of the sacroiliac joint (SIJ). From my experience and reading I have found that there is a higher incidence than many papers have found in regards to prevalence of low back pain. Also many of the tests are very subjective for the patient or examiner, with poor inter tester reliability. In addition many papers do not indicate the level of training of the assessors or training of interpretation of a positive result for the various tests used.

What I find very interesting is the link between the hip/groin and SIJ...some papers leave this and focus more on SIJ provocation rather than rationalise the link between the hip/groin and SIJ for various testing such as Gaelensen's test and FABER. However many papers include these as primary tests. This does rarely cover SIJ caused hip/groin pain in absence of low back provocation.

I tend to use a combination of the following (in order of preference...but of course depending on the presentation):

Direct:
Active Straight Leg Raise
Gillet's/Stork standing test
Gaelensen's test (with hand under pelvis)
*Pull test (Not real name...patient supine. stand at end of bed and pull down long axis of leg. +ve if reduced inferior pelvic movement (ASIS and pubis)
Quadrant
FABER
Fortin Finger test (well der...um..."point to your pain")


Indirect:
Lumbar Extension/Quadrant range of movement and associated pain
Pelvic symmetry in supine
Adductor length/strength
Leg length test at lateral malleolus
Piriformis length/strength
IlioPsoas length/strength
Gluteal length/strength
Hip Rotation
Ober's
Straight Leg Raise

Utilised infrequently
Compression
Distraction
Thigh Thrust

Not utilised
POSH (POsterior SHear test)
Drop test
Palpation of joint play
Sacral thrust

Please let me know of your test battery or at least Direct tests! If we can start a discussion on the SIJ and or testing that would be great!!!

Thanks in advance.
-Jay


*if you know the name of this test please let me know, I cant find it in the literature or internet.

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[Braedan@ Physio Surrey]

JayPhysio,

Great discussion thread. I'm thinking about your request and try as I might, I can't bring myself to type out a list of orthopaedic tests. The reason why I can't, has a great deal to do with the nature of the SI joint. The way I was taught, we are actually discussing the lumbo/pelvic/hip complex. The way I work, I look to diagnose the pain generating tissue, and also the mechanical dysfunctions in the area of the pain generating tissue. For example, you mentioned hip/groin pain ... absolutely, the SI is important to consider. So here's how I would go about considering/assessing it:

• lumbar mechanics
• Sacral mechanics
• ilium mechanics
• symphysis mechanics
• Hip joint mechanics
• local Soft tissue mechanics
• Distal soft tissue and joint mechanics
• Assessment of pain generator

You should use whatever positional, motion, palpation, or specialized tests that you need to understand that patients mechanics so that you can generate an effective treatment plan.

After all, isn't it all about the Outcomes?

Braedan
From the Total Outcomes Surrey Physio Project!