The Value of Medical History and Physical Examination in Diagnosing Sacroiliac Joint Pain

Abstract

Study Design 

This prospective study evaluated the diagnostic utility of historically accepted sacroiliac joint tests. A multidisciplinary expert panel recommended 12 of the “best” sacroiliac joint tests to be evaluated against a criterion standard of unequivocal pain relief after an intra-articular injection of local anesthetic into the sacroiliac joint.

Objectives 

To identify a single sacroiliac joint test or ensemble of tests that are sufficiently useful in diagnosing sacroiliac joint disorders to be clinically valuable.

Summary of Background Data 

No previous research has been done to evaluate any physical test of sacroiliac joint pain against an accepted criterion standard.

Methods 

Historical data was obtained, and the 12 tests were performed by two examiners on 85 patients who subsequently underwent sacroiliac joint blocks. Ninety percent or more relief was considered a positive response, and less then 90% relief was considered a negative response.

Results 

There were 45 positive and 40 negative responses. No historical feature, none of the 12 sacroiliac joint tests, and no ensemble of these 12 tests demonstrated worthwhile diagnostic value.

Conclusion 

Sacroiliac joint pain is resistant to identification by the historical and physical examination data from tests evaluated in this study.