Common Provocative Tests for SI Joint Pain Diagnosis
G. “Ty” Thaiyananthan MD, FAANS: One of the ways that we as doctors can diagnose SI joint pain is to perform some maneuvers in the clinic called provocative test that place stress on the joint to replicate SI joint pain. Some of the more common provocative clinical exams for diagnosing SI joint dysfunction resulting in SI joint pain include a Gaenslen's test. With this test is we are actually going to have the side that’s affected hanging off the edge of the table and we are going to apply a downward force and a rotational force across the joint to see if we can replicate the pain in that joint. Unlike the other test, this test specifically creates a rotational force across the joint. So, I need you to have you come over the edge of the table and the key to this test is really to have the joint off the edge of the table and what we are going to do is we are going to let this leg hang, so it gives us a plain where we actually rotate the joint through and I am going to bend this leg and I am going to apply force that pushes out on this knee and down on this afflicted joint creating a rotational force across the joint. Do you feel pain over that? Patient: I do. Ty: Okay.
The Faber's test or flexion abduction external rotation test, for this test I need to make a figure four with your leg and this case we are going to be testing the left side. Am going to apply some pressure to your hip, on your right hip and I am going to push downwards on your left knee. It is that where you are having a low back pain after the side. Patient: Yes.
Ty: Does it radiate down to your leg. Patient: Yes. Ty: Okay, perfect. The thigh thrust, I am going to have you bend your leg here, it is a same concept what we are going to do is, we are going to be applying a downward force through your SI joint to see if this replicates your pain. It a constant force where we push down on your knee straight down perpendicular to the table. Do you feel that? Patient: I do.
Ty: Okay, and the compression and distraction exams. For this, I need to have you lie on your side okay we are gong to have you lie on your right side, and typically what I do is we put the afflicted side up and there is a couple of different techniques we are doing this. We could actually do it either way, my preferences is to have the afflicted side up and I am going to apply a constant downward force pushing straight down through your SI joint to see if we can replicate the pain. Do you feel anything? Patient: I do.
Ty: Okay, perfect. The next test that we are going to do is for the converse of the compression test called the distraction exam, and what we are going to do is we are going to apply force distract over the joint to see if we can replicate your pain. The concept is to apply force going outwards, so we are going to apply some force going outwards like that, does I creat pain. Patient: Yes, it does. Ty: Okay, the key with this test is the mixture of the force is going outwards and not necessarily pushing down. If you have at least three of these tests which are positive, there is a good likelihood you may be having pain that is originating from SI joint and you may be a good candidate for some of the treatments that are out there for treating SI joint dysfunction.
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