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Sacroiliac lesions
In order to reach the conclusion of sacroiliac pathology we have to make a distinction between pain provocation tests and mobility tests ; the latter being highly unreliable.
A few simple tests can be sufficient.
Using pain provocation tests at least 5 tests need to be positive in case of a symptomatic SI problem.
Sacroiliac lesions
The SI-joint joint is probably one of the most controversial diagnostic issues.
In general, I am convinced that an SI diagnosis is usually an example of "artificial hypercomplication" of diagnostic procedures and the "specific" treatment techniques are merely "wishful thinking".
Research has demonstrated that mobility tests of the SI joint are inherently unreliable. Some pain provocation tests, however are reliable, and therefore are mentioned in this procedure.
Basic history
The patient describes unilateral gluteal pain, with possible radiation into the S1-S2-dermatome. Alternating low gluteal pain is seen in young males, suffering from ankylosing spondylitis. Sometimes sitting on the affected gluteal area is painful.
There are no dural signs nor symptoms.
Basic clinical image
Perhaps the patient describes end-range pain on lumbar flexion and ipsilateral side flexion. SLR might be end-range painful too.
Possibly there is a contralateral deviation in standing.
Pain provocation tests (a selection)
* Patrick's test : the patient is in supine lying. Ipsilateral hip flexion, abduction and lateral rotation is built in ; on the contralateral side pressure is applied on the SAIS, followed by provocation.
* Gaenslen's test : the patient is in supine lying with maximal contralateral hip flexion and with the other leg hanging over the boarder of the couch. This is also a multi-provocation test (both SI-joints are tested, both hip joints, the psoas muscle and the femoral nerve).
* Yeoman's test : this is also a multi-provocation test. The patient is in prone lying : maximum hip extension is built in, with fixation of the sacrum, resulting in an anterior ilium rotation.
* Axial pressure.
* Pressure on the anterolateral aspect of the iliac crest.
Remark : the reliable clinical determination of an SI- dysfunction or -subluxation still remains very unclear.
(Part I, p191, 202-203)
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