Informative value of physical provocative tests and treatment-diagnostic blocks for differentiation of iliolumbar ligament syndrome

Abstract

Informative value of provocative tests and a treatment-diagnostic block for differentiation of iliolumbar ligament syndrome was determined. Results of diagnostic examination of 174 patients with ligamentogenic lumbopelvic pain, where 97 cases revealed iliolumbar ligament syndrome and 77 patients had pathology of the sacrotuberous and/or sacrospinal ligaments, were analysed. It was found out that adduction of the hip, flexed at the right angle, with a subsequent pressure along its axis resulted in the largest sensitivity (Se=70.09%) and specificity (Sp=73.68%) for differential diagnosis of the source of ligamentogenic lumbopelvic pain in patients with iliolumbar ligament syndrome. This finding makes it possible to consider the above test as pathognomic, even in conditions of negative results of other provocative tests, and the one that substantiates a treatment-diagnostic block as the next diagnostic step. A combination of the test (adduction of the hip, flexed at the right angle, with a subsequent pressure along its axis), pathognomic for iliolumbar ligament syndrome, with a rotation test had a high sensitivity (Se=73.17%) and specificity (Sp=86.27%), thereby being a more valuable informative index for differential diagnosis of this ligamentosis. A combination with a diagnostic block increased diagnostic accuracy up to 98%. Keywords: lumbopelvic pain, iliolumbar ligament, provocative tests, treatment-diagnostic block.