Relative Sensitivity, Specificity and Perceived Exertion of Some Provocative Tests in the Mechanical Diagnosis of Sacro-Iliac Joint Dysfunction among Patients with Low Back Pain

Michael O Egwu

doi:10.4172/2161-0533.1000130

Abstract

Purpose: Provocative tests are known to be clinically useful in the identification of soft tissue and articular dysfunctions, however, the proportion of patients with Sacro-Iliac Joint (SIJ) dysfunction who have positive tests (sensitivity) and the proportion who have negative tests (specificity) for these tests are not well known. This study examined the relative sensitivity, specificity and associated stress of Gross SIJ Compression (GSIJC) and Distraction (GSIJD), Supine-Long Sitting (SLS) and Posterior Dimple Compression (PDC) tests among patients with Low Back Pain (LBP). Method: Fifty three subjects (male-24, female-29; age range 19-90 years, mean age 57.6yrs) went through the four tests and the test that elicited pain and/or limb length discrepancy (positive test) were noted. Pain intensity was rated using semantic differential scale before and after testing, while test induce exertion was assessed using Borge scale after testing. GSIJC test was set as gold standard for the purpose of analysis. Result: PDC (0.91) was more sensitive than SLS (0.67) and GSIJD (0.57, while GSIJD was more specific (0.91) than SLS (0.84) and PDC (0.56). However, PDC was the least exerting (7.2) followed by GSIJD (7.5), SLS (13.0) and GSIJC (13.9). Conclusion: PDC test is the least exerting and more able to identify the proportion of LBP patients having SIJ dysfunction while GSIJD is more able to identify the proportion of Patients with LBP without SIJ dysfunction but exert more stress on the patient without gender bias.

Highlights

Low Back Pain (LBP) is often described as specific or non-specific
Sacro-Iliac Joint (SIJ) dysfunction refers to pain in the SIJ region that is caused by abnormal motion in the SIJ and it is divided into intra and extra articular dysfunction with the intra articular pathologies including the above mentioned red flags
The Gross Sacro-Iliac Joint Compression (GSIJC) and GSIJD tests were selected because Laslett et al [11,16] observed that these tests were good predictors of a positive intra articular SIJ block, while Supine Long – Sitting (SLS) was selected because SIJ dysfunction is known to result in apparent limb length discrepancy (Figure 7) [3,16]

Summary

Introduction

Low Back Pain (LBP) is often described as specific (clearly defined) or non-specific (not clearly defined). SIJ dysfunction refers to pain in the SIJ region that is caused by abnormal motion in the SIJ and it is divided into intra and extra articular dysfunction with the intra articular pathologies including the above mentioned red flags. Extra articular SIJ dysfunction is a disorder of abnormal joint movement and alignment owing to disruption of the posterior ligamentous support system [2]. This leads to recurrent hyper/hypo mobility, inflammation and in more severe cases, instability and recurrent subluxation that eventuate into pain in the low back, gluteal regoin, sciatic - leg, groin and hip. Other symptoms may include urinary frequency and transient numbness [3,4]

Methods

Results

Conclusion