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Keywords

Diagnostic testing and physical examination: spine, thorax, and abdomen; low back pain; sacroiliac joint

Abstract

Sacroiliac joint (SIJ) pain serves as an under-recognized source of chronic low back pain. Improvement in the accuracy of a clinical SIJ pain diagnosis lends a higher likelihood of appropriate treatment measures, better patient outcomes and decreased out-of-pocket costs. Therefore, the overall purpose of this evidence to practice review was to highlight the main points of a systematic review on the clinical diagnosis of SIJ pain. Searches of five electronic databases revealed 758 studies, nonetheless only six studies met final inclusion criteria. Studies included were assessed by the authors for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Evidence suggests pain provocation tests including distraction, thigh thrust, compression, sacral thrust, and Gaenslen’s are minimally useful individually at diagnosing sacroiliac joint pain. The thigh thrust test was the most sensitive and the distraction test was most specific. Furthermore, the compression test carried the strongest positive likelihood ratio. The highest likelihood ratio was reported when three or more of the following pain provocation tests were positive: distraction, compression, thigh thrust, sacral thrust, and Gaenslen’s test for both the right and left sides. A comparable likelihood ratio was found when any two of the remaining four tests were positive after excluding the left and right-side applications of the Gaenslen’s test. Prior to the performance of pain provocation tests, research suggests using McKenzie Mechanical Diagnosis and Therapy to exclude pain of disc origin. The use of safe, efficient, and clinically effective diagnostic evaluation techniques is essential to the provision of high-quality patient care.

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