Posterior Shear 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 Editors''' - [http://www.physio-pedia.com/index.php5?title=User:Els_Van_Haver Els Van haver] | |||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | |||
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== Search Strategy == | |||
Search engines PubMed, Web of Knowledge, Pedro<br>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<br> | |||
== Purpose == | |||
< | The posterior pelvic pain provocation test is a pain provocation test used to determine the presence of sacroiliac dysfunction. It is used (oftenly 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 also known as: | |||
*PPPP test | |||
*P4 test | |||
*Thigh trust test | |||
*Posterior shear test<br> | |||
*POSH test<br> | |||
== Technique<br> == | == Technique<br> == | ||
With the patient supine, the hip is flexed to 90° (with bended knee) to stretch the posterior structures and the femur is adducted towards the midline. 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.<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="Elf">P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119</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><br> | |||
The test is positive for pelvic girdle pain if the axial pressure provoques pain over the sacroiliac joint of the provoked side that is familiar to the patient. | |||
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| {{#ev:youtube|sJLRimMDR_E|300}}<ref>Thigh trust test. Available from: http://www.youtube.com/watch?v=sJLRimMDR_E [last accessed 1/12/11]</ref> | |||
| {{#ev:youtube|Va-2ReIvwJk|300}}<ref>Thigh trust test. Available from: http://www.youtube.com/watch?v=Va-2ReIvwJk [last accessed 1/12/11]</ref> | |||
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== Evidence == | == Evidence == | ||
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.<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> 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). <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> 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:<ref name="Zes" /> | |||
*[[Distraction Test|Distraction test]] | |||
*[[SI compression test|Compression test]] | |||
*Thigh trust test | |||
*[[Gaenslen Test|Gaenslen’s test]] | |||
*Sacral trust test | |||
= | Lanslet et al (2005) state that no further examination is wishfull if both distraction and thigh trust 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" /> | ||
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.<ref name="Drie" /><ref name="Zes" /><ref name="Vijf" /> 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" /> | |||
== | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=14exR3zaRr4JG3vzwq-ymdrjYpsEtlWCJ05z-1Kw8n12ysDYf9|charset=UTF-8|short|max=10</rss> | |||
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== References == | |||
<references /> | <references /> | ||
Revision as of 11:41, 2 December 2011
Original Editors - Els Van haver
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
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 (oftenly 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 trust 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 and the femur is adducted towards the midline. 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.[2][3][4]
The test is positive for pelvic girdle pain if the axial pressure provoques pain over the sacroiliac joint of the provoked side that is familiar to the patient.
| [5] | [6] |
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.[7][8] 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). [9][2][10] 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:[10]
- Distraction test
- Compression test
- Thigh trust test
- Gaenslen’s test
- Sacral trust test
Lanslet et al (2005) state that no further examination is wishfull if both distraction and thigh trust 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.[9]
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.[9][10][2] Positive predictive value ranges from 25% to 70% and negative predictive value goes from 88% to 92%.[11][10]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ JK Freburger, DL Riddle. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001; 81:1135–1143
- ↑ 2.0 2.1 2.2 NA Broadhurst, MJ Bond. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spine Disorders. 1998; 11(4):341–345
- ↑ P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119
- ↑ 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
- ↑ Thigh trust test. Available from: http://www.youtube.com/watch?v=sJLRimMDR_E [last accessed 1/12/11]
- ↑ Thigh trust test. Available from: http://www.youtube.com/watch?v=Va-2ReIvwJk [last accessed 1/12/11]
- ↑ BA Zelle, GS Gruen, S Brown, S George. Sacroiliac dysfunction: evolution and management. Clin J Pain. 2005; 21(5):446-455
- ↑ JK Freburger, DL Riddle. Using Published Evidence to Guide the Examination of the Sacroiliac Joint Region. Physical Therapy. 2001; 81(5):1135-1143
- ↑ 9.0 9.1 9.2 M Laslett et al. Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 2005; 10:207-218
- ↑ 10.0 10.1 10.2 10.3 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
- ↑ 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)
