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SIJ Dysfunction: How do we identify it and which cluster do we use?

3/25/2013

4 Comments

 
SIJ Dysfunction is a pathology that is still under debate, regarding its prevalence. There are some PT schools and some physicians that believe pain can not originate from the joint and that movement is not possible. This can be questioned by the presentation of patients with asymmetrical pelvic alignment that is corrected with Muscle Energy Techniques (METs), often with a relief of pain. Other studies have shown that injections of anesthesia in the Sacroiliac Joint can relieve symptoms. This is frequently known as the gold standard for identifying SIJ Dysfunction but is not necessarily practical due to the skill and cost required. Physical tests are much preferred.
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As you might be aware, there are quite a few tests out there for the Sacroiliac Joint, many of which are based on alignment. Due to the low inter-rater and intra-rater reliability of these tests based on identifying asymmetries, pain provocation tests are preferred when identifying pain arising from the Sacroiliac Joint. Unfortunately, there is not one pain provocation test that has been shown to have sufficient diagnostic accuracy by itself. This has led to the use of clusters. Two of the commonly used clusters include: a) SIJ compression, SIJ distraction, POSH Test, Sacral Clearing Test, Resisted Abduction Test; b) POSH Test, Resisted Abduction Test, FABER Test. But how do we decide which one to use? This is an example of why we need to review the literature to assess the methodological quality.

Broadhurst and Bond performed a double blind study that utilized placebo and active injections to find the effects of each test. Pain had to be decreased by 70% to be determined as originating from the SIJ. None of those injected with saline had a sufficient decrease in pain. The study found that when Resisted Abduction Test, POSH Test, and FABER Test were clustered together, there was a high likelihood of pain of SIJ origin. This test, upon initial examination, appears to have respectable methodological quality. Stuber performed a systematic review that ended up including 6 studies that looked at special tests identifying SIJ Dysfunction. Broadhurst and Bond's study was included in the review. One of the components of the study was to assess methodological quality of each one. Broadhurst and Bond's study was ranked 3rd overall, due to deficits in number of participants, drop outs, and lack of description of the examiners and tests performed.  While the cluster suggested by Broadhurst and Bond may still be useful, we should be cautious given the methodological flaws.

The cluster with the highest evidence according to Stuber includes:
-SIJ Compression
-SIJ Distraction
-POSH Test
-Sacral Thrust
-Resisted Abduction Test

When any three tests out of the five listed below are positive, there is a sensitivity of .87 and a specificity of .91
4 Comments
Louie Puentedura
3/25/2013 02:35:27 am

I have to take issue with this statement.
"This can be questioned by the presentation of patients with asymmetrical pelvic alignment that is corrected with Muscle Energy Techniques (METs), often with a relief of pain."
Assessment of pelvic asymmetry has no reliability or validity, so how can it be seen to be 'corrected' with METs?
Also, I'd refer you to a newer study by Mark Laslett
http://www.ncbi.nlm.nih.gov/pubmed/16038856

Reply
Met professor
6/26/2013 12:27:56 pm

That is an old study and has no use clinically that was utilised for research purposes to prove that sij pain exists. You obviously don't now what you are talking about. Lee and hungerford have presented numerous studies the gillet or stork test in weight bearing and non weight bearing and active straight leg raise.

Reply
Chris link
3/25/2013 10:09:55 am

Louie, thank you for you comment! I would agree I probably worded that statement poorly. I completely agree with you in regards to poor reliability and validity with assessing SIJ Dysfunction based on palpation or tests that rely on assessing symmetry, as stated above. I was directing that statement toward the relief of pain that can be achieved following a MET, showing how pain can originate from the SIJ. Thank you for the article as well! This '05 article was actually included in the '07 systematic review by Stuber cited above and had the highest level of methodological quality, based on the studies included. The findings in the Laslett article were included in the Stuber article to determine the importance of using a cluster for SIJ Dysfunction.

Reply
Muhammad Ayaz link
11/22/2018 08:35:33 am

Sir we manage SIJ dysfunction?

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test