Background: Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of
lumbar pain, its anatomical position and the absence of a diagnostic ‘gold standard’ lead to
difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks
only provide information about pathologies of joint origin and since SIJD developing secondary
to pathologies in structures around the joint can be missed. Provocation and palpation tests
also need to be used in diagnosis.
Objectives: The purpose of this study was to examine the reliability of clinical examination
and provocation tests used in the diagnosis of SIJD.
Study Design: Retrospective analysis of prospectively collected data.
Setting: Outpatient physical medicine and rehabilitation clinic.
Methods: One hundred and seventeen patients presenting with lumbar and/or leg pain and
diagnosed with SIJD through clinical evaluation were included in the study. Range of lumbar
joint movement, pain location and specific tests used in the diagnosis of SIJD were evaluated.
Positivity in 3 out of 6 provocation tests was adopted as the criterion.
Results: 75.2% of patients were female and 24.8% were male. Mean age was 46.41 ± 10.45
years. A higher level of females was determined in ender distribution. SIJD was determined
on the right in 52.6% of patients and on the left in 47.4%. When SI joint provocation tests
were analyzed individually, the highest positivity, in 91.4% patients diagnosed with SIJD, was
in the FABER test. The lowest positivity, in 56.4% of patients, was determined in the Ganslen
test. The same patients were assessed by the same clinician at 2 different times. In these data,
the simple consistence, kappa and PABAK coefficient values of all tests were close to 1 and
indicating good agreement. The thigh thrust (POSH) and sacral thrust tests exhibited very good
agreement with a kappa coefficient of 0.90 and a PABAK coefficient of 0.92, while the FABER
test exhibited good agreement with a kappa coefficient of 0.78 and a PABAK coefficient of
0.92.
Limitation: Agreement between different observers was not evaluated, and also no
comparison was performed with SI joint injection, regarded as a widely used diagnostic
technique.
Conclusion: The anatomical position of the SI joint and the lack of a diagnostic ‘gold
standard’ make the examination and diagnosis of SIJD difficult. Most SI joint clinical tests have
limited reliability and validity on their own, while a multitest regimen consisting of SI joint pain
provocation tests is a reliable method, and these tests can be used instead of unnecessary
invasive diagnostic SI joint procedures.
Key words: Dysfunction, lumbar, sacroiliac joint, provocation test, sacroiliac joint pain, pain
pattern
The Validity and Reliability of Provocation Tests
in the Diagnosis of Sacroiliac Joint Dysfunction