Sacroiliac Joint Special Test Cluster: Difference between revisions
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== Background == | == Background == | ||
Test Item Cluster (TIC) is a group of special tests which are developed to facilitate clinical decision making by improving the diagnostic utility. | Test Item Cluster (TIC) is a group of special tests which are developed to facilitate clinical decision making by improving the diagnostic utility. | ||
A study by Levangie et al<ref name="Levangie">Levangie P. Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain. Phys Ther. 1999;79:1043-1057</ref> had developed a TIC for identifying SIJ dysfunction with the following tests: standing flexion test, sitting PSIS palpation, supine long sitting test, and prone knee flexion test. The investigators assessed the diagnostic utility of those tests by comparing findings of patients who complained of LBP with those of patients being treated for other physical impairments not related to the back. They reported that the cluster of these tests exhibited a sensitivity of 0.82, specificity of 0.88, + LR of 6.83, and - LR of 0.20. It needs to be noted, however, that the reliability of those special tests used for this TIC is poor. Inter-rater reliability kappa values of standing flexion test, sitting PSIS palpation, and prone knee flexion test are reported as follows: 0.08 - 0.32, 0.23 - 0.37, 0.21 - 0.26 respectively.<ref name="Cleland">Cleland J. Orthopaedic clinical examination: an evidence-based approach for physical therapists. Saunders: Elsevier, 2007</ref> Additionally, validity of the results should be evaluated carefully due to the reference standard used for this study. | A study by Levangie et al<ref name="Levangie">Levangie P. Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain. Phys Ther. 1999;79:1043-1057</ref> had developed a TIC for identifying SIJ dysfunction with the following tests: standing flexion test, sitting PSIS palpation, supine long sitting test, and prone knee flexion test. The investigators assessed the diagnostic utility of those tests by comparing findings of patients who complained of LBP with those of patients being treated for other physical impairments not related to the back. They reported that the cluster of these tests exhibited a sensitivity of 0.82, specificity of 0.88, + LR of 6.83, and - LR of 0.20. It needs to be noted, however, that the reliability of those special tests used for this TIC is poor. Inter-rater reliability kappa values of standing flexion test, sitting PSIS palpation, and prone knee flexion test are reported as follows: 0.08 - 0.32, 0.23 - 0.37, 0.21 - 0.26 respectively.<ref name="Cleland">Cleland J. Orthopaedic clinical examination: an evidence-based approach for physical therapists. Saunders: Elsevier, 2007</ref> Additionally, validity of the results should be evaluated carefully due to the reference standard used for this study. | ||
== <span class="Apple-style-span" style="font-size: 13px; ">More recently, Laslett et al<ref name="Laslett et al">Laslett M, Aprill CN, MCDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual Therapy 2005;10:207-218</ref> investigated the diagnostic power of pain provocation sacroiliac joint (SIJ) tests individually and in various combinations, in relation to a diagnostic injection. The tests employed in this study were: distraction, right sided thigh thrust, right sided Gaenslen's test, compression and sacral thrust. Those tests were chosen due to its acceptable inter-rater reliability. They found that composites of provocation SIJ tests had significant diagnostic utility. Any 2 of 4 selected tests (distraction, thigh thrust, compression, and sacral thrust) have the best predictive power. When all 6 SIJ provocation tests does not reproduce symptoms, the SIJ pathology can be ruled out. </span> == | == <span class="Apple-style-span" style="font-size: 13px;">More recently, Laslett et al<ref name="Laslett et al">Laslett M, Aprill CN, MCDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual Therapy 2005;10:207-218</ref> investigated the diagnostic power of pain provocation sacroiliac joint (SIJ) tests individually and in various combinations, in relation to a diagnostic injection. The tests employed in this study were: distraction, right sided thigh thrust, right sided Gaenslen's test, compression and sacral thrust. Those tests were chosen due to its acceptable inter-rater reliability. They found that composites of provocation SIJ tests had significant diagnostic utility. Any 2 of 4 selected tests (distraction, thigh thrust, compression, and sacral thrust) have the best predictive power. When all 6 SIJ provocation tests does not reproduce symptoms, the SIJ pathology can be ruled out. </span> == | ||
== <span class="Apple-style-span" style="font-size: 13px; "></span>Description of Provocation Tests == | == <span class="Apple-style-span" style="font-size: 13px;"></span>Description of Provocation Tests<ref name="cleland" /><br> == | ||
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| Sacral Thrust | | Sacral Thrust | ||
| Pt prone. Examiner delivers an anteriorly directed thrust over the sacrum. (+: reproduction of pain) | | Pt prone. Examiner delivers an anteriorly directed thrust over the sacrum. (+: reproduction of pain) | ||
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== <span class="Apple-style-span" style="font-size: 13px;"></span>Diagnostic Value of Individual SIJ Provocation Tests<ref name="Lasette et al" /><br> == | |||
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Laslett et al <ref name=" | <br> | ||
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== TIC for SIJ Provocation Tests == | |||
Laslett et al<ref name="Laslette et al" /> reported that the Gaenslen's test did not contribute positively when tests were combined and may be omitted from the diagnostic process without compromising diagnostic confidence. The optimal rule was to perform the <u>distraction, compression, thigh thrust and sacral thrust tests</u> but stopping when there are 2 positives. The diagnostic value of 2 positive tests of the 4 selected test was as follows: | |||
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| Values (95% CI) | | Values (95% CI) | ||
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| Sensitivity | | Sensitivity | ||
| 0.88 (0.64, 0.97) | | 0.88 (0.64, 0.97) | ||
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| Specificity | | Specificity | ||
| 0.78 (0.61, 0.89) | | 0.78 (0.61, 0.89) | ||
|- | |- | ||
| + LR | | + LR | ||
| 4.00 (2.13, 8.08) | | 4.00 (2.13, 8.08) | ||
|- | |- | ||
| - LR | | - LR | ||
| 0.16 (0.04, 0.47) | | 0.16 (0.04, 0.47) | ||
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< | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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== References == | |||
References will automatically be added here, see [[Adding References|adding references tutorial]]. | |||
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Background[edit | edit source]
Test Item Cluster (TIC) is a group of special tests which are developed to facilitate clinical decision making by improving the diagnostic utility.
A study by Levangie et al[1] had developed a TIC for identifying SIJ dysfunction with the following tests: standing flexion test, sitting PSIS palpation, supine long sitting test, and prone knee flexion test. The investigators assessed the diagnostic utility of those tests by comparing findings of patients who complained of LBP with those of patients being treated for other physical impairments not related to the back. They reported that the cluster of these tests exhibited a sensitivity of 0.82, specificity of 0.88, + LR of 6.83, and - LR of 0.20. It needs to be noted, however, that the reliability of those special tests used for this TIC is poor. Inter-rater reliability kappa values of standing flexion test, sitting PSIS palpation, and prone knee flexion test are reported as follows: 0.08 - 0.32, 0.23 - 0.37, 0.21 - 0.26 respectively.[2] Additionally, validity of the results should be evaluated carefully due to the reference standard used for this study.
More recently, Laslett et al[3] investigated the diagnostic power of pain provocation sacroiliac joint (SIJ) tests individually and in various combinations, in relation to a diagnostic injection. The tests employed in this study were: distraction, right sided thigh thrust, right sided Gaenslen's test, compression and sacral thrust. Those tests were chosen due to its acceptable inter-rater reliability. They found that composites of provocation SIJ tests had significant diagnostic utility. Any 2 of 4 selected tests (distraction, thigh thrust, compression, and sacral thrust) have the best predictive power. When all 6 SIJ provocation tests does not reproduce symptoms, the SIJ pathology can be ruled out. [edit | edit source]
Description of Provocation Tests[4]
[edit | edit source]
| Tests | Description (Positive Findings) |
| Distraction | Pt supine. Examiner applies posterolateral directed pressure to bilateral ASIS. (+: reproduction of pain) |
| Compression | Pt sidelying. Examiner compresses pelvis with pressure applied over the iliac crest directed at the opposite iliac crest. (+: reproduction of symptoms) |
| Thigh Thrust | Pt supine. Examiner place hip in 90 deg flexion and adduction. Examiner then applies posteriorly directed force through the femur at varying angles of abduction/adduction. (+: reproduction of buttock pain) |
| Gaenslen's | Pt supine with both legs extended. The test leg is passively brought into full knee flexion, while the opposite hip remains in extension. Overpressure is then applied to the flexed extremity. (+: reproduction of pain) |
| Sacral Thrust | Pt prone. Examiner delivers an anteriorly directed thrust over the sacrum. (+: reproduction of pain)
|
Diagnostic Value of Individual SIJ Provocation Tests[5]
[edit | edit source]
| Distraction | Compression | Thigh Thrust | Gaenslen's (R) | Gaenslen's (L) | Sacral Thrust | |
| Sensitivity | 0.60 | 0.69 | 0.88 | 0.53 | 0.50 | 0.63 |
| Specificity | 0.81 | 0.69 | 0.69 | 0.71 | 0.77 | 0.75 |
| + LR | 3.20 | 2.20 | 2.80 | 1.84 | 2.21 | 2.50 |
| - LR | 0.49 | 0.46 | 0.18 | 0.66 | 0.65 | 0.50 |
TIC for SIJ Provocation Tests[edit | edit source]
Laslett et al[6] reported that the Gaenslen's test did not contribute positively when tests were combined and may be omitted from the diagnostic process without compromising diagnostic confidence. The optimal rule was to perform the distraction, compression, thigh thrust and sacral thrust tests but stopping when there are 2 positives. The diagnostic value of 2 positive tests of the 4 selected test was as follows:
| Values (95% CI) | |
| Sensitivity | 0.88 (0.64, 0.97) |
| Specificity | 0.78 (0.61, 0.89) |
| + LR | 4.00 (2.13, 8.08) |
| - LR | 0.16 (0.04, 0.47) |
Recent Related Research (from Pubmed)[edit | edit source]
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Levangie P. Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain. Phys Ther. 1999;79:1043-1057
- ↑ Cleland J. Orthopaedic clinical examination: an evidence-based approach for physical therapists. Saunders: Elsevier, 2007
- ↑ Laslett M, Aprill CN, MCDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual Therapy 2005;10:207-218
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedcleland - ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedLasette et al - ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedLaslette et al
