Provocative tests for sacroiliac joint dysfunction

Journal/Book: Rehab in Review Vol. 6 Nr.10 1998 / Phys Rehab Kur Med 9 (1999) S. M31. 1998 / 1999;

Abstract: Broadhurst NA et al.: Pain Provocation Tests for the Assessment of Sacroiliac joint Dysfunction. J. Spinal. Disord. 11 (4) (1998) 341-345 Previous studies have suggested that the etiology of low back pain (LBP) involves sacroiliac joint (SI) dysfunction in up 60 30% of patients. However reliable tests to diagnose Sl dysfunction are lacking. This study sought to determine whether three commonly used provocation tests are sufficiently reliable to determine that pain originates from the Sl joint. Forty patients presenting with symptoms suggestive of Sl joint pain were randomized to receive either one percent lignocaine or normal saline injections to the affected joint. Prior to injection three common maneuvers to assess the Sl joint were performed and then repeated 15 to 30 minutes after injection. Maneuvers included the FABER (Flexion Abduction and External Rotation) POSH (Posterior Shear) and REAB (Resisted Abduction) tests. Pre- and post-injection pain levels were then determined using a visual analog score (VAS) ranging from zero to 100. A 70% reduction of pain in the injected joint was considered a positive outcome for pain arising from the Sl joint. The results revealed that after injection of one percent lignocaine 14 to 20 patients had 70 % or better improvement in pain as per the FABER test (sensitivity 77% specificity 100%). Fifteen of 20 patients using the POSH test (sensitivity 80% and specificity 100%) and 17 to 20 patients using the REAB test (sensitivity 87% and specificity 100%) experienced 70% or better pain improvement. No patient who received normal saline experienced significant improvement in pain. Conclusion: This study of three commonly used provocation tests for Sl joint pain suggests that the tests are sufficiently reliable to be used in the clinical setting. When used in combination the tests result in higher sensitivity and specificity in confirming the origin of pain from the Sl joint. ___MH

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