Diagnosis Of Sacroiliac Joint Pain Research Articles

Family History of Sacroiliac Joint Pain as a Risk Factor for Development of Sacroiliac Joint Pain: A Case-Control Study

Background: Chronic lower-back pain is among the most common health problems and accounts for a significant amount of disability worldwide. Sacroiliac joint (SIJ) pain is one of the leading causes of lower-back pain; however, diagnosis of SIJ pain can sometimes be challenging. Family history is a known predictive factor for arthritis in both seropositive and seronegative arthropathies, including osteoarthritis; however, the role of family history in SIJ pain has not been studied. Study: This case-control study examined whether family history of SIJ pain is a risk factor for developing SIJ pain. Discussion: Results indicate that a high proportion of patients with SIJ pain reported positive family history of SIJ pain (58.6% vs 10.5%, P < .001). Cases were 6.5 times more likely than controls to report any relative with history of SIJ pain. Conclusion: Patients with a prior family history of SIJ pain can be identified early, monitored closely, diagnosed early, and started on aggressive physical therapy and close follow-up. Key words: Sacroiliac joint pain, sacroiliac joint dysfunction

The Combined Effectiveness of Piriformis Stretch and Muscle Activation Exercises in Patients with Sacroiliac Joint Pain.

Sacroiliac joint pain is one of the common misdiagnosed orthopedic causes of low back pain, which affects between 15 to 30 percent of individuals with mechanical low back pain below L5. The sacroiliac joint is found out to be a source of dysfunction and pain in 10% to 27% of suspected cases of patients with chronic low back pain. Clinicians use different electrotherapy modalities, biomechanical correction techniques, and exercises for addressing SI joint pain. Many studies have been undertaken to find out the efficacy of different treatment tools in combination or isolation. Likewise, there are studies done to understand the effect of piriformis stretch and muscles activation exercises on sacroiliac joint pain but, there exists very little evidence studying the combined effect of both the treatment tools. So our study aims to determine the combined effect of piriformis stretch and muscles activation exercises in patients with sacroiliac joint pain. About 30 subjects, both male and female with a primary diagnosis of sacroiliac joint pain by the physician were recruited into two groups. Group A having 15 patients received piriformis stretch and muscles activation exercises, and Group B having 15 patients received only muscles activation exercises. All the subjects received therapy sessions thrice weekly for four weeks. Outcome measures used were the visual analog scale (VAS) and oswestry disability index(ODI). Pre- intervention assessment and post-intervention assessment was carried out for both groups and the received data was analyzed using paired and independent t-test. According to the results of the analysis, the average improvement of VAS for Group A and Group B were 2.33 and 3.53 respectively. The paired t-test was 23.129 and 14.270, which is statistically highly significant (p-value = 0.000). The average improvement in oswestry disability index for group A and group B were 16.13 and 26.13 respectively using mean and standard deviation. The paired t-test was 11.014 and 6.934 respectively, which is statistically highly significant (p-value = 0.000). There is a significant improvement in both Group A and Group B. However, Group A (piriformis stretch and muscle activation exercises) showed significant improvement in the treatment of sacroiliac joint pain. The results indicated that both Group A and Group B had significant improvement in the scores of VAS and ODI scores at the 4th week when compared to baseline values, but when comparing the end results of group A and group B, it has been found out that group A intervention is more effective than Group B in treating patients with sacroiliac joint pain. From the data analysis reports, it can be concluded that when these treatment tools i.e piriformis stretch and muscles activation exercises are applied in combination, it gives better results in the management of sacroiliac joint pain

A Narrative Review of Anatomy and Clinical Biopsychosocial Assessment of Sacroiliac Joint Pain

Sacroiliac Joint (SIJ) pain is a severe disorder that affects 15% to 25% of individuals having axially low back pain. The most common causes of depressive symptoms are fear of movement, pain catastrophising, stress, and nervous system sensitisation. Recent research has shown that radiological imaging, are inadequate for diagnosing SIJ pain. For immersive and patient centred experiences, a comprehensive professional Biopsychosocial (BPS) physiotherapy evaluation is suggested. A new biopsychosocial model has been proposed that acknowledges all critical health and disease factors and promotes the interaction of biological, psychological, and social influences, but moves further than a narrow perspective. Psychosocial influences on well-being have generated an interest in physician services, physiotherapy evaluation, and implementation in a more systematic approach to a patient. This method is used to determine the current pain mechanism (predominant nociceptive, neuropathic, or non neuropathic central sensitisation pain) as well as the underlying pain mechanism. Patient’s biopsychosocial variables can establish and maintain SI discomfort. For a better plan of therapy to manage SIJ dysfunction, the biopsychosocial clinical assessment takes precedence over the examination of sacroiliac joint discomfort alone.

The effect of minimally invasive sacroiliac joint fusion compared with sham operation: study protocol of a prospective double-blinded multicenter randomized controlled trial

Background and purpose — The sacroiliac joint is increasingly recognized as a cause of pain in 15–30% of patients with low back pain. Nonoperative management is not always successful and surgical treatment with fusion of the joint is increasingly recommended. According to the literature, minimally invasive fusion reduces pain and improves function compared with nonoperative treatment. It is, however, unclear to what extent the placebo effect influences these results. Patients and methods — The trial is designed as a prospective multi-center, double-blind, randomized sham-surgery controlled trial with 2 parallel groups. 60 patients with a suspected diagnosis of sacroiliac joint pain confirmed with sacroiliac joint injection are included according to the trial inclusion criteria. Patients are randomized with a 1:1 allocation into 2 groups of 30 patients each. The primary end-point is group difference in sacroiliac joint pain intensity on the operated side at 6 months postoperatively, measured by the Numeric Rating Scale. The main objective is to examine whether there is a difference in pain reduction between patients treated with a minimally invasive fusion of the sacroiliac joint compared with patients undergoing a sham operation. Results — Unblinding occurs after the completed 6-month follow-up. The primary analysis will be performed when all patients have completed 6 months’ follow-up. Follow-ups are continued to at least 2 years postoperatively. Data from the different groups will be compared based on the “intention to treat” principle.

Successful Diagnosis of Sacroiliac Joint Dysfunction.

BackgroundSacroiliac joint (SIJ) pain is one of the most common causes of low back pain, accounting for 15 to 30% of all cases. Although SIJ dysfunction accounts for a large portion of chronic low back pain prevalence, it is often overlooked or under diagnosed and subsequently under treated. The purpose of this review was to establish a best practices model to effectively diagnose SIJ pain through detailed history, physical exam, review of imaging, and diagnostic block.MethodsA literature search was performed on the diagnosis of sacroiliac joint pain and sacroiliac joint dysfunction. The authors proposed diagnostic recommendations based upon the available literature and a detailed understanding of diagnosing SIJ pain.ResultsThe practitioner must focus on the history, location of pain, observed gait pattern, and perform key points of the physical exam including sacroiliac provocative maneuvers. If the patient exhibits at least three provocative maneuvers then the SIJ may be considered as a possible source of pain. Additionally, a thorough review of the imaging should be performed to rule out other etiologies of low back pain. In the absence of any pathognomonic tests or examination findings, diagnostic SIJ blocks have evolved as the diagnostic standard.ConclusionThe diagnosis of SIJ pain is a multifaceted process that involves a careful assessment including differentiating other pain generators in the region. This involves careful history taking, appropriate physical examination including provocative maneuvers and diagnostic injections. Once the diagnosis is confirmed, long-term solutions may be considered, including recent advances in sacral lateral branch denervation and sacroiliac joint fusion.

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

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.

Diagnosis of Sacroiliac Joint Pain: Predictive Value of Three Diagnostic Clinical Tests.

To date, there have been no acceptable and accurate diagnostic criteria or standards of care for the management of sacroiliac joint (SIJ) pain. Several studies have yielded different contributions of clinical presentation, history, and physical examination in the diagnosis of SIJ pain. Our goal in this study was to assess the sensitivity and specificity of the diagnostic clinical tests and their predictive value in accurately diagnosing SIJ pain. Upon enrolling 200 eligible patients with SIJ pain as their primary diagnosis, they were re-evaluated and their verbal rating scale (VRS) pain scores and demographic data were obtained. Thereafter, three SIJ diagnostic tests were performed: the thigh thrust test, the Patrick test, and a modified version of the Gaenslen test that is referred to as the Mekhail test. Subsequently, the patients were taken to the procedure room to undergo SIJ injection, for which a confirmative result was≥50% pain relief. The physicians performing the procedure were blinded of the results of the 3 tests performed. Results from the 3 tests were incorporated with the procedure results, from which we drew statistical and medical conclusions determining their predictive value and degree of aid to physicians in diagnosing SIJ pain. We found that the cumulative effect of adding simultaneous tests increased the sensitivity of the testing but decreased the specificity, which generates a powerful screening tool. The combination of the Patrick and Mekhail tests demonstrated the best accuracy, with 94% sensitivity, 17% specificity, 81% positive predictive value, and 44% negative predictive value. The Patrick test was better than other tests for differentiating patients with SIJ pain from those with non-SIJ pain. No combination yielded both significant sensitivity and specificity. Generally, the overall predictive value of any of the tests on their own or their combination did not vary significantly from the predictive value of baseline demographics, including pre-injection pain score and pain referral diagram. In conclusion, our study results were similar to those of previous investigators who found that physical examination plays a limited role in diagnosing SIJ pain. Specifically, we found that the clinical tests and/or their combinations added no significant predictive capacity compared to patients' baseline characteristics in predicting the response to diagnostic SIJ injection, albeit the combination of the Mekhail and Patrick tests yielded high sensitivity (94%), making them viable for consecutive screening, possibly reducing the unnecessary costs of diagnostic SIJ injection procedures.

Diagnosing and Managing Sacroiliac Joint Pain.

Sacroiliac joint pain commonly occurs because of anatomic disruption within the joint. Sacroiliac joint pain and sacroiliac joint mimics create a broad differential, adding difficulty to diagnosis. Clinically, this disruption presents with a mobility limitation relative to baseline and sharp pain inferolateral to the posterior superior iliac spine. While attempting to rule out other causes of low back pain, provocation tests such as FABRE, distraction, thigh thrust, sacral compression, Gaenslen's, and sacral thrust can be a useful diagnostic tool for the diagnosis of sacroiliac joint pain. Although recently, the provocation tests' validity has been challenged. Currently, the most accurate way to assess sacroiliac joint pain is with image-guided injections of local anesthetic. Pain reduction after the injection indicates the pain originating from the sacroiliac joint. Once confirmed, it is recommended to use a patient-centered approach that focuses on pain control, followed by restoration of function through noninvasive measures such as therapeutic exercise, manual medicine, sacroiliac joint belts, and orthotics. If these noninvasive procedures have not provided adequate treatment, then more invasive procedures should be considered.

Pain generator sacroiliac joint : Functional anatomy, symptoms and clinical significance

The sacroiliac joint is acommon cause of low back pain. Due to variable symptoms, the diagnosis is often very difficult. For diagnosis, systemic disease, as well as pathologies in the hips and lumbar spine must be excluded. To describe anatomy and function of the joint and underlying pathologies. To present the evidence of actual diagnostic and therapeutic options. An extensive literature research was carried out on PubMed. The sacroiliac joint is an important and biomechanically complex joint. There are many controversial diagnostic tests to identify the sacroiliac joint as asource of pain. The cause of the dysfunction must be identified in order to treat it correctly and to prevent achronification of the pain. The gold standard is conservative care. The sacroiliac joint must be included in the differential diagnosis in patients with low back pain. Diagnostic tests are often insufficient for the diagnosis of sacroiliac joint pain. Many of the current diagnostic and therapeutic options present weak evidence.

Image-Guided Sacroiliac Joint Injections: an Evidence-based Review of Best Practices and Clinical Outcomes.

Injections into the intraarticular sacroiliac joint (SIJ) are commonly done for both diagnostic and therapeutic reasons. Injection of an anesthetic can aid in the diagnosis of SIJ pain. Corticosteroids can be administered with the goal of providing a therapeutic effect. This article summarizes the literature regarding the diagnostic and therapeutic effects of these injections. It includes a review of the various imaging modalities including fluoroscopy, ultrasound, and computed tomography guidance, as well as a discussion on the prevalence data and other variables that may affect the reported outcomes.

Sacroiliac joint pain following iliac-bone marrow aspiration and biopsy: a cohort study.

Background: Sacroiliac joint (SIJ) pain is a common source of lower back pain; the factors associated have not been studied in cancer patients. Observing patients with bone marrow aspiration and biopsy (BMAB) who subsequently developed SIJ-pain led to this investigation. Aim: To investigate this possible relationship. Methods: A cohort study of cancer patients diagnosed with SIJ pain. The association of BMAB with SIJ pain was evaluated, as were variables that differed between the groups. Results: The prevalence of SIJ pain was 4.95% (231/4669). Among 231 patients with SIJ pain, 34% (78/231) did not have prior history of lower back pain and had undergone BMAB prior to their diagnosis of SIJ pain. A statistically significant association between BMAB-SIJ-pain was found (p <0.01). Conclusion: We found linear correlation between BMAB and subsequent SIJ pain.

Efficacy of Sacro-Occipital Technique on Sacroiliac Joint Instability in Females

AbstractBackground: Sacroiliac function is considered to be important in many manual therapy systems because of the complexity and location of the Sacroiliac joint in the kinetic chain, moreover 98% of patients having low back pain had mechanical dysfunction of the sacroiliac joints.Aim of Study: The aim of this study is to explore the effect of Sacro-occipital technique on pelvic obliquity in patients with Sacroiliac joint instability.Patients and Methods: Thirty female patients were ran-domly assigned into two groups and each group consists of 15 patient. Control Group (A) treated by Therapeutic ultrasound and study Group (B) treated by Sacro-occipital technique + Pelvic belt + Therapeutic ultrasound. Referred from orthopedist with the diagnosis of Sacroiliac joint pain with mean age, weight and height 29.5 (3.8) years, 74.7 (5.3) kg, and 163 (4.4) cm respectively. Pelvic obliquity was objectively meas-ured by using pelvic inclinometer.Results: No statistically significant difference between groups in pelvic obliquity before treatment. But a significant reduction in pelvic obliquity was observed in the study group (B) compared to the control group (A).Conclusion: The study proved that Sacro ocipital technique decreased the pelvic obliquity in patient with sacro iliac joint instability.

Diagnosing Sacroiliac Joint Pain.

The sacroiliac joint (SIJ) is a diarthrodial joint that has been implicated as a pain generator in approximately 10% to 25% of patients with mechanical low back or leg symptoms. Unique anatomic and physiologic characteristics of SIJ make it susceptible to mechanical stress and also create challenges in the diagnosis of SIJ pain. A variety of inciting causes for SIJ pain may exist, ranging from repetitive low-impact activities such as jogging to increased stress after multilevel spine fusion surgery to high-energy trauma such as in motor vehicle accidents. Similarly, wide variability exists in the clinical presentation of SIJ pain from localized pain or tenderness around the SIJ to radiating pain into the groin or even the entire lower extremity. No pathognomonic clinical history, physical examination finding, or imaging study exists that aids clinicians in making a reliable diagnosis. However, imaging combined with clinical provocative tests might help to identify patients for further investigation. Although provocative physical examination tests have not received reliable consensus, if three or more provocative tests are positive, pursuing a diagnostic SIJ injection is considered reasonable. Notable pain relief with intra-articular anesthetic injection under radiographic guidance has been shown to provide reliable evidence in the diagnosis of SIJ pain.

A Randomized Controlled Trial of Fluoroscopically-Guided Sacroiliac Joint Injections: A Comparison of the Posteroanterior and Classical Oblique Techniques.

ObjectiveThe sacroiliac joint can be a primary source of pain or part of multifactorial syndromes. As there is no single historical, physical examination-based, or radiological feature that definitively establishes a diagnosis of sacroiliac joint pain, diagnostic blocks are regarded as the gold standard. The primary aim of this randomized trial was to compare the posteroanterior approach with the classic oblique approach for sacroiliac joint injection based on an assessment of procedure times and patient-reported pain outcomes in subjects scheduled for fluoroscopically-guided sacroiliac joint injections. MethodsThirty patients were randomized into 2 groups of 15 patients each. The endpoints measured included the total length of procedure time, fluoroscopic time, needling time (length of time the needle was maneuvered), and pre- and postprocedure visual analogue scale pain scores. ResultsThe posteroanterior approach was significantly shorter in terms of procedure time (p=0.03) and needling time (p=0.01) than the oblique approach. Adjusting for body mass index, the mean procedure and needling times were significantly shorter in the posteroanterior group than in the oblique group. ConclusionThis study of the posteroanterior approach for fluoroscopic-guided sacroiliac joint injection observed shorter times for fluoroscopy, needling, and the overall procedure than were recorded for the widely prevalent oblique approach. This may translate to lower radiation exposure, lower procedural costs, and enhanced ergonomics of fluoroscopicallyguided sacroiliac joint injections.

Lumbar Radiofrequency Rhizotomy in Patients with Chronic Low Back Pain Increases the Diagnosis of Sacroiliac Joint Dysfunction in Subsequent Follow-Up Visits

Chronic back pain is often a result of coexisting pathologies; secondary causes of pain can become more apparent sources of pain once the primary pathology has been addressed. The objective of our study was to determine if there is an increase in diagnosis of Sacroiliac joint pain following a Lumbar Rhizotomy. A list of patients who underwent Lumbar Radiofrequency during a 6-month period in our clinic was generated. Records from subsequent clinic visits were reviewed to determine if a new diagnosis of SI joint pathology was made. In patients who underwent a recent Lumbar Rhizotomy procedure to treat facetogenic pain, the prevalence of Sacroiliac joint pain increased to 70%. We infer that there is a significant increase in the diagnosis of Sacroiliac joint syndrome following a Lumbar Rhizotomy, potentially due to unmasking of a preexisting condition. In patients presenting with persistent back pain after Lumbar Rhizotomy, the clinician must have a high degree of suspicion for latent Sacroiliac joint pain prior to attributing the pain to block failure. It would be prudent to use >80% relief of pain after a diagnostic medial branch block as a diagnostic criterion for facetogenic pain rather than the currently accepted >50% in order to minimize unmasking of preexisting subclinical pain from the SI joint.

Patients with Sacroiliac Joint Pain and Arthritis

Chronic pain originating from the sacroiliac joint (SIJ) is common. Pathophysiology is often related to biomechanical derangement affecting the SIJ or traumatic, degenerative, arthritic, and idiopathic changes of the SIJ. Diagnosis of SIJ pain is suggested by typical patterns of distribution, pain characteristics, and a combination of provocative tests, confirmed by diagnostic block of the SIJ, and differentiated from several other causes of low back pain. Multimodal therapy includes educational, physical, pharmacologic, interventional, and surgical approaches and should be individualized. The efficacy and safety of radiofrequency denervation of the sacroiliac joint have been demonstrated in randomized controlled trials. Multiple modalities of radiofrequency treatment exist, and comparative effectiveness studies are required to determine the most efficacious and cost-effective treatment modality. This review contains 1 highly rendered figure and 33 references.

Patients with Sacroiliac Joint Pain and Arthritis

Chronic pain originating from the sacroiliac joint (SIJ) is common. Pathophysiology is often related to biomechanical derangement affecting the SIJ or traumatic, degenerative, arthritic, and idiopathic changes of the SIJ. Diagnosis of SIJ pain is suggested by typical patterns of distribution, pain characteristics, and a combination of provocative tests, confirmed by diagnostic block of the SIJ, and differentiated from several other causes of low back pain. Multimodal therapy includes educational, physical, pharmacologic, interventional, and surgical approaches and should be individualized. The efficacy and safety of radiofrequency denervation of the sacroiliac joint have been demonstrated in randomized controlled trials. Multiple modalities of radiofrequency treatment exist, and comparative effectiveness studies are required to determine the most efficacious and cost-effective treatment modality.

Pain Pressure Threshold in the Region of the Sacroiliac Joint in Patients Diagnosed with Sacroiliac Joint Pain

Background: Although the prevalence of sacroiliac joint (SIJ) pain is relatively high (15 – 30%), there is no unambiguous reference standard to diagnose SIJ pain. Pressure tenderness in the SIJ region is used for diagnostic purposes, but the clinimetric properties of this procedure remain to be determined. Objectives: The aim of this study is to determine the reliability of pain pressure threshold (PPT) measurements in the SIJ region and the difference in PPTs in the SIJ region between healthy volunteers and PPTs in patients with SIJ pain. Study Design: Prospective cohort study. Setting: Outpatient pain clinic VU University Medical Center. Methods: Forty-one healthy volunteers and 31 patients diagnosed with SIJ pain were included. PPTs were obtained from 5 measurement points in the region of the SIJ with a pressure pain algometer using a standardized protocol. The inter-rater reliability of this method was calculated by means of the Intraclass Correlation Coefficients (ICC) of individual assessment performed by 2 individual raters of SIJs of healthy volunteers on both sides. PPTs of healthy volunteers were compared to those of the affected side in patients with SIJ pain. Results: PPT measurement showed moderate to good inter-rater reliability (ICC 0.6 – 0.82).The median PPTs of 5 points was comparable for both sides in healthy volunteers (right: 8.5 kg/cm2 [IQR 6.0 – 10.0]; left 8.3 kg/cm2 (5.8 – 10.0]). Median PPTs for the affected sides of patients with SIJ pain were significantly lower compared to the same side of healthy volunteers (right: 2.4 kg/cm2 [IQR 2.2 – 3.2, n = 15]; left: 2.5 kg/cm2 [2.3 – 3.2, n = 16]; P &lt; 0.001 for both sides). Limitations: Only the SIJ on one side of was measured in patients with SIJ pain, where both sides would be desirable. Conclusions: Pressure pain algometry appears to be a reliable method to establish differences in PPTs between healthy volunteers and patients with SIJ pain. The diagnostic accuracy of this test should be investigated further. Key words: Sacroiliac joint pain, pain pressure threshold, pressure algometry

The Interventional Pain Management of Sacroiliac Joint Pain: A Brief Review

The sacroiliac joint accounts for approximately 10% to 25% of cases of chronic mechanical low back pain. Some pain provocation sacroiliac joint tests can be used in diagnosing sacroiliac joint pathology. However, none of the provocative sacroiliac tests alone were found to have positive predictive value for diagnosing sacroiliac joint pain. Diagnostic sacroiliac joint injections is considered to be the best diagnostic method. Intra-articular injections, periarticular injections, conventional radiofrequency, pulsed-radiofrequency and cooled-radiofrequency neuromodulations are the interventional pain management methods of sacroiliac joint. The evidence for cooled radiofrequency neurotomy treatment seems to be fair according to the treatment guidelines. The evidence for intraarticular steroid injections, periarticular injections with steroids, pulsed radiofrequency, and conventional radiofrequency neurotomy seem to be limited (or poor) for short-term and long-term pain relief.

Value of Examination Under Fluoroscopy for the Assessment of Sacroiliac Joint Dysfunction

Background: Pain emanating from the sacroiliac (SI) joint can have variable radiation patterns. Single physical examination tests for SI joint pain are inconsistent with multiple tests increasing both sensitivity and specificity. Objective: To evaluate the use of fluoroscopy in the diagnosis of SI joint pain. Study Design: Prospective double blind comparison study Setting: Pain clinic and radiology setting in urban Veterans Administration (VA) in New Orleans, Louisiana. Methods: Twenty-two adult men, patients at a southeastern United States VA interventional pain clinic, presented with unilateral low back pain of more than 2 months’ duration. Patients with previous back surgery were excluded from the study. Each patient was given a Gapping test, Patrick (FABERE) test, and Gaenslen test. A second blinded physician placed each patient prone under fluoroscopic guidance, asking each patient to point to the most painful area. Pain was provoked by applying pressure with the heel of the palm in that area to determine the point of maximum tenderness. The area was marked with a radio-opaque object and was placed on the mark with a fluoroscopic imgage. A site within 1 cm of the SI joint was considered as a positive test. This was followed by a diagnostic injection under fluoroscopy with 1 mL 2% lidocaine. A positive result was considered as more than 2 hours of greater than 75% reduction in pain. Then, in 2-3 days this was followed by a therapeutic injection under fluoroscopy with 1 mL 0.5% bupivacaine and 40 mg methylprednisolone. Results: Each patient was reassessed after 6 weeks. The sensitivity and specificity in addition to the positive and negative predictive values were determined for both the conventional examinations, as well as the examination under fluoroscopy. Finally, a receiver operating characteristic (ROC) curve was constructed to evaluate test performance. The sensitivity and specificity of the fluoroscopic examination were 0.82 and 0.80 respectively; Positive predictive value and negative predictive value were 0.93 and 0.57 respectively. The area under ROC curve was 0.812 which is considered a “good” test; however the area under ROC for the conventional examination were between 0.52 -0.58 which is considered “poor to fail”. Limitations: Variation in anatomy of the SI joint, small sample size. Conclusions: Multiple structures of the SI joint complex can result in clinical symptoms of pain. These include intra-articular structures (degenerative arthritis, and inflammatory conditions) as well as extraarticular structures (ligaments, muscles, etc.). Key words: Sacroilliac joint disease, radicular pain, thigh thrust test, compression test, distraction test, Gaenslen test, Patrick test (FABER test)