Posterior Pelvic Pain Provocation Test: Difference between revisions

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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
'''Original Editor '''- [[User:Kevin Savage|Kevin Savage]]  
'''Original Editors''' -&nbsp; [http://www.physio-pedia.com/index.php5?title=User:Els_Van_Haver Els Van haver]  


'''Lead Editors'''  &nbsp;   
'''Lead Editors'''  &nbsp;   
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== Purpose<br> ==
== Search Strategy ==


The Posterior Shear Test (POSH Test) is a provocation test used to determine if a patient's pain is coming from the sacral iliac joint. &nbsp;The actual name of this test as written in all of Laslett's work as the "Thigh Thrust Test".<ref name="Laslett 2003" /><ref name="Laslett 2005" /><br>  
Search engines &nbsp; &nbsp; &nbsp; &nbsp;PubMed, Web of Knowledge, Pedro<br>Keywords &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Posterior pelvic pain/Pelvic girdle pain/Sacroiliac pain + Provocation test* + &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Reliability/Sensitivity/Specificity/Validity
 
Searches have been performed between 28/10/2011 and 01/12/2011<br>
 
== Purpose  ==
 
The posterior pelvic pain provocation test is a pain provocation test used to determine the presence of [[Sacroiliac joint|sacroiliac dysfunction]]. It is used (often in pregnant women) to distinguish between pelvic girdle pain and low back pain.<ref name="Zeven">JK Freburger, DL Riddle. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001; 81:1135–1143</ref>  
 
The test is&nbsp;also known as:
 
*PPPP test
*P4 test
*Thigh thrust test
*Posterior shear test<br>  
*POSH test<br>


== Technique<br>  ==
== Technique<br>  ==


With the patient supine, flex the patient's hip to 90 degrees.&nbsp; Then the examiner applies an axial force posteriorly through the femur at varying angles of hip abduction and adduction.&nbsp; The test is considered positive if it reproduces the patients buttock pain.  
With the patient supine, the hip is flexed to 90° (with bended knee) to stretch the posterior structures. By applying axial pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly. One hand is placed beneath the sacrum to fixate its position while the other hand is used to apply a downward force to the femur. Broadhurst &amp; Bond suggest to add hip adduction towards the midline while Laslett &amp; Williams advise to avoid excessive adduction due to discomfort for the patient.&nbsp;<ref name="Elf">P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119</ref><ref name="Vijf">NA Broadhurst, MJ Bond. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spine Disorders. 1998; 11(4):341–345</ref><ref name="Tien">M Laslett. Pain provocation sacroiliac joint tests: reliability and prevalence. In: Vleeming A, Mooney V, Snijders CJ, Dormann TA, Stoeckart R, editors. Movement, Stability and Low Back Pain: The Essential Role of the Pelvis. 1st ed. New York: Churchill Livingstone; 1997</ref><ref>Laslett M, Williams M. The reliability of selected pain provocation test for sacroiliac joint pathology. Spine 1998; 19(11): 1243-1249</ref>


{{#ev:youtube|tabgNzqhTUQ|300}}<ref>Clinically Relevant Technologies http://www.youtube.com/watch?v=tabgNzqhTUQ; accessed May 2011</ref>  
The test is positive for pelvic girdle pain if the axial pressure provokes pain over the sacroiliac joint that is familiar to the patient.
 
{| width="100%" cellspacing="1" cellpadding="1"
|-
| {{#ev:youtube|sJLRimMDR_E|300}}<ref>Thigh thrust test. Available from: http://www.youtube.com/watch?v=sJLRimMDR_E [last accessed 1/12/11]</ref>
| {{#ev:youtube|Va-2ReIvwJk|300}}<ref>Thigh thrust test. Available from: http://www.youtube.com/watch?v=Va-2ReIvwJk [last accessed 1/12/11]</ref>
|}


== Evidence  ==
== Evidence  ==


Laslet, et al, report the specificity as high as 100% (<ref name="Laslett 2003">Laslett M, April CN, McDonald B, Young SB. Diagnosing Painful SI joints: A validation study of Mckenzie and SI provocation tests. Aust J Physiotherapy. 2003; 49:89-97.</ref>,<ref name="Laslett 2005">Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of SI joint pain: validity of individual provocation test and composites of tests. Manual Therapy 2005; 10:207-218.</ref>) and Broadhurst, et al, report the sensitivity as high as 80% (<ref>Broadhurst NA, Bond MJ. Pain Provocation tests for the assessment of SI joint dysfunction. Jrnl of Spine Disorders 1998; 11(4):341-345.</ref>), demonstrating good positive and negative predictive values.&nbsp; The POSH test was only on of a few sacral-iliac joint tests that had both positive and negative predictive capabilities (<ref>Mousaui SJ, Mousaui L, Alavizadeli A, Kamal S. Jrnl of Research in Rehabilitation Sciences; Vol 3, No.1(86).</ref>).
The gold standard to evaluate sacroiliac pain provocation tests is an intra-articular injection of a local anesthetic into the sacroiliac joint, under guidance of radiological imaging.Several studies have compared existing pain provocation tests and concluded that not a single test but an [[Test Item Clusters for Sacroiliac Dysfunction|array of tests]] should be used to confirm diagnosis (grade A recommendation). There is level 1A evidence stating that a combination of positive tests (2 out of 4, 3 out of 5,…) produces a high likelihood ratio. Most commonly used tests with both sensitivity and specificity greater than 60% are:&nbsp;<ref name="Zes" /><ref name="Acht">BA Zelle, GS Gruen, S Brown, S George. Sacroiliac dysfunction: evolution and management. Clin J Pain. 2005; 21(5):446-455</ref><ref name="Negen">JK Freburger, DL Riddle. Using Published Evidence to Guide the Examination of the Sacroiliac Joint Region. Physical Therapy. 2001; 81(5):1135-1143</ref><ref name="Drie">M Laslett et al. Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 2005; 10:207-218</ref><ref name="Vijf" /><ref name="Zes">KJ Stuber. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. J Can Chiropr Assoc. 2007; 51(1): 30-41</ref>  
 
*[[Distraction Test|Distraction test]]
*[[SI compression test|Compression test]]
*Thigh thrust test
*[[Gaenslen Test|Gaenslen’s test]]
*[[Sacral trust test|Sacral thrust test]]


== Resources  ==
Lanslet et al (2005) state that no further examination is wishfull if both distraction and thigh thrust test provoke familiar pain because of their high individual sensitivity and specificity. If only one test or 2 other tests are positive, further testing is required to obtain a valid result.<ref name="Drie" />&nbsp;


Wikipedia and AAOS
The posterior pelvic pain provocation test has a high intertester reliability of 94,1 (kappa=0,64-0,82 and p&lt;0,001) and a high degree of sensitivity (80-88%) and specificity (100%) in 2 studies of moderate to high methodological quality.&nbsp;Positive predictive value ranges from 25% to 70% and negative predictive value goes from 88% to 92%.<ref name="Vier">CC Yung, M Fredericson, M Smuck. Sacroiliac Joint Pain Syndrome in Active Patients - A Look Behind the Pain. The Physician and Sports Medicine 2002; 30(11)</ref><ref name="Zes" /><ref name="Drie" /><ref name="Zes" /><ref name="Vijf" />


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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== References  ==
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
<references />
 
<references />  
 
  [[Category:Assessment]] [[Category:EIM_Residency_Project]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Pelvis]] [[Category:Special_Tests]] [[Category:Videos]]

Revision as of 16:26, 14 June 2013

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors -  Els Van haver

Lead Editors  

Search Strategy[edit | edit source]

Search engines        PubMed, Web of Knowledge, Pedro
Keywords                 Posterior pelvic pain/Pelvic girdle pain/Sacroiliac pain + Provocation test* +                                                                      Reliability/Sensitivity/Specificity/Validity

Searches have been performed between 28/10/2011 and 01/12/2011

Purpose[edit | edit source]

The posterior pelvic pain provocation test is a pain provocation test used to determine the presence of sacroiliac dysfunction. It is used (often in pregnant women) to distinguish between pelvic girdle pain and low back pain.[1]

The test is also known as:

  • PPPP test
  • P4 test
  • Thigh thrust test
  • Posterior shear test
  • POSH test

Technique
[edit | edit source]

With the patient supine, the hip is flexed to 90° (with bended knee) to stretch the posterior structures. By applying axial pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly. One hand is placed beneath the sacrum to fixate its position while the other hand is used to apply a downward force to the femur. Broadhurst & Bond suggest to add hip adduction towards the midline while Laslett & Williams advise to avoid excessive adduction due to discomfort for the patient. [2][3][4][5]

The test is positive for pelvic girdle pain if the axial pressure provokes pain over the sacroiliac joint that is familiar to the patient.

[6]
[7]

Evidence[edit | edit source]

The gold standard to evaluate sacroiliac pain provocation tests is an intra-articular injection of a local anesthetic into the sacroiliac joint, under guidance of radiological imaging.Several studies have compared existing pain provocation tests and concluded that not a single test but an array of tests should be used to confirm diagnosis (grade A recommendation). There is level 1A evidence stating that a combination of positive tests (2 out of 4, 3 out of 5,…) produces a high likelihood ratio. Most commonly used tests with both sensitivity and specificity greater than 60% are: [8][9][10][11][3][8]

Lanslet et al (2005) state that no further examination is wishfull if both distraction and thigh thrust test provoke familiar pain because of their high individual sensitivity and specificity. If only one test or 2 other tests are positive, further testing is required to obtain a valid result.[11] 

The posterior pelvic pain provocation test has a high intertester reliability of 94,1 (kappa=0,64-0,82 and p<0,001) and a high degree of sensitivity (80-88%) and specificity (100%) in 2 studies of moderate to high methodological quality. Positive predictive value ranges from 25% to 70% and negative predictive value goes from 88% to 92%.[12][8][11][8][3]

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

  1. ↑ JK Freburger, DL Riddle. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001; 81:1135–1143
  2. ↑ P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119
  3. ↑ 3.0 3.1 3.2 NA Broadhurst, MJ Bond. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spine Disorders. 1998; 11(4):341–345
  4. ↑ M Laslett. Pain provocation sacroiliac joint tests: reliability and prevalence. In: Vleeming A, Mooney V, Snijders CJ, Dormann TA, Stoeckart R, editors. Movement, Stability and Low Back Pain: The Essential Role of the Pelvis. 1st ed. New York: Churchill Livingstone; 1997
  5. ↑ Laslett M, Williams M. The reliability of selected pain provocation test for sacroiliac joint pathology. Spine 1998; 19(11): 1243-1249
  6. ↑ Thigh thrust test. Available from: http://www.youtube.com/watch?v=sJLRimMDR_E [last accessed 1/12/11]
  7. ↑ Thigh thrust test. Available from: http://www.youtube.com/watch?v=Va-2ReIvwJk [last accessed 1/12/11]
  8. ↑ 8.0 8.1 8.2 8.3 KJ Stuber. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. J Can Chiropr Assoc. 2007; 51(1): 30-41
  9. ↑ BA Zelle, GS Gruen, S Brown, S George. Sacroiliac dysfunction: evolution and management. Clin J Pain. 2005; 21(5):446-455
  10. ↑ JK Freburger, DL Riddle. Using Published Evidence to Guide the Examination of the Sacroiliac Joint Region. Physical Therapy. 2001; 81(5):1135-1143
  11. ↑ 11.0 11.1 11.2 M Laslett et al. Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 2005; 10:207-218
  12. ↑ CC Yung, M Fredericson, M Smuck. Sacroiliac Joint Pain Syndrome in Active Patients - A Look Behind the Pain. The Physician and Sports Medicine 2002; 30(11)
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