Best Practices for Clinical Evaluation of Sacroiliac Joint Pain: An Evidence-to-Practice Review

Abstract

Sacroiliac joint (SIJ) pain serves as an under-recognized source of chronic low back pain. Improvement in the accuracy SIJ pain diagnosis lends a higher likelihood of appropriate treatment measures, better patient outcomes and decreased out-of-pocket costs. Therefore, the overall purpose of the guiding paper was to systematically review and synthesize evidence associated with the clinical diagnosis of SIJ pain. Searches of 5 electronic databases revealed 758 studies, nonetheless only 6 studies met final inclusion criteria. Studies included in the guiding systematic review were assessed for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Evidence suggests pain provocation tests including distraction, compression, thigh thrust, sacral thrust, and Gaenslen’s are useful individually at diagnosing sacroiliac joint pain. The thigh thrust test was most sensitive and the distraction test was most specific. Furthermore, the compression test carried the strongest positive likelihood ratio. The highest likelihood ratio was reported when three or more of the following pain provocation tests were positive: distraction, compression, thigh thrust, sacral thrust, and Gaenslen’s test for both the right and left sides. A comparable likelihood ratio was found when any two of the remaining four tests were positive after excluding the left and right-side applications of the Gaenslen’s test.  Research suggests using the McKenzie evaluation to exclude pain of disc origin preceding the performance of pain provocation tests in an effort to further reduce false positives. Safe, effective, and efficient diagnostic evaluation techniques are essential to the provision of high-quality patient care.