The Importance of Considering Medication Effects During Evaluations

Recently, I was evaluating a patient that presented with a subjective history typical of Sacroiliac Joint Dysfunction. Additionally, she presented with an asymmetrical pelvic alignment: superior R iliac crest and PSIS along with asymmetrical pubic symphysis that was painful upon provocation.  As you all know after our previous post, there is poor diagnostic accuracy when using alignment for diagnosis of SIJ Dysfunction. On the other hand, pain provocation tests are extremely effective in identifying individuals suffering from pain originating in the Sacroiliac Joint. Knowing that, I jumped to one of the SIJ clusters to rule in the pathology. I was extremely surprised to find that she was negative on all of the tests! Following a MET to restore symmetry in the pelvis, the patient's pain disappeared. Recognizing my confusion, my clinical instructor reminded me that she was currently on a steroid taper, along with a few other pain meds. In fact, the pathology was screaming at me with all of the subjective complaints, but I was too focused on the negative results of the SIJ cluster. This explained why I was unable to recreate the pain though testing. So, the lesson learned is be sure to take into account the current effects of any medications that might alter response to examination. Our tests and clusters with high evidence will not always be as effective as we think, and sometimes we have to lean more on the subjective findings.