Clinical Diagnosis of Sacroiliac Joint Pain

Abstract

There is a need to establish a standardized clinical examination, based on best available evidence, that identifies those patients with persistent back and buttock pain whose symptoms arise from the sacroiliac joint. This clinical examination is the first step in the selection of patients for controlled and guided diagnostic intra-articular block (the reference standard). This in turn is the prerequisite for selection of patients for minimally invasive therapies such as intra-articular steroid injection or for surgical fusion. The use of pain location and results from pain provocation tests is described within the context of a clinical reasoning algorithm. A cluster of at least 2, preferably 3 provocation tests in the absence of any clear diagnosis of a pain source other than the sacroiliac joint, has a sensitivity of 91% and specificity of 89%. The clinical examination described is reliable, requires no special equipment, and is available from trained clinicians in most developed countries.