What is included in the physical exam to evaluate sacroiliac joint (SIJ) injuries?

Answer

The reliability of the physical examination findings to diagnose SIJ dysfunction has been addressed in several articles. The usual pattern of examination is discussed, as follows:

Inspection often reveals a pelvis with asymmetric height. This finding can be an indication of unilateral restriction in motion of one or both SIJs. Standing flexion testing involves the comparison of the symmetry of motion between the PSIS on the tested side and the S2 spinous process (Gillet test). However, Freburger and Riddle questioned the reliability of examinations between testers.^[11]
Of paramount importance is to measure the limb lengths to look for inequality, inspect the lumbar spine to look for scoliosis, and rotate the hips to look for motion restriction.
Palpation may be the most reliable indication of SIJ pain. The patient usually places a thumb directly onto one particular spot in the dimple of the PSIS (sacral sulcus). The patient can usually precisely reproduce the pain over that one spot (Fortin finger sign).^[9]More diffuse back or buttock and leg pain should prompt the clinician to question the diagnosis of SIJ dysfunction (see Differentials and Other Problems to Be Considered).
Upon neurologic examination, motor strength, sensory examination, and reflexes in the lower extremities should all prove normal. However, sometimes, strength examination proves challenging, and the patient may exhibit weaknesses because of pain inhibition or frank muscle imbalance that developed during episodes of pain and relative inactivity. True neurogenic weakness, numbness, or loss of reflex should alert the clinician to consider nerve root injury or pathology other than a mechanical dysfunction.

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Goldwaith JH, Osgood RB. A consideration of the pelvic articulations from an anatomical pathological and clinical standpoint. Boston Med Surg J. 1905. 152(21):593-601.
Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine. 1995 Jan 1. 20(1):31-7. [Medline].
Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. 1987 Apr. 217:266-80. [Medline].
Edge-Hughes L. Hip and sacroiliac disease: selected disorders and their management with physical therapy. Clin Tech Small Anim Pract. 2007 Nov. 22(4):183-94. [Medline].
Foley BS, Buschbacher RM. Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil. 2006 Dec. 85(12):997-1006. [Medline].
Frieberg AH, Vinke TH. Sciatica and the sacroiliac joint. Clin Orthop Relat Res. 1974. 16:126-34.
Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine. 2003 Jul 15. 28(14):1593-600. [Medline].
Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine. 1994 Jul 1. 19(13):1475-82. [Medline].
Fortin JD, Falco FJ. The Fortin finger test: an indicator of sacroiliac pain. Am J Orthop. 1997 Jul. 26(7):477-80. [Medline].
Thawrani DP, Agabegi SS, Asghar F. Diagnosing Sacroiliac Joint Pain. J Am Acad Orthop Surg. 2018 Oct 1. [Medline].
Freburger JK, Riddle DL. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001 May. 81(5):1135-43. [Medline]. [Full Text].
Stuber KJ. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. JCCA J Can Chiropr Assoc. 2007 Mar. 51(1):30-41. [Medline].
Hancock MJ, Maher CG, Latimer J, et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J. 2007 Oct. 16(10):1539-50. [Medline].
Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998 Mar. 79(3):288-92. [Medline].
Dreyfuss P, Dryer S, Griffin J, Hoffman J, Walsh N. Positive sacroiliac screening tests in asymptomatic adults. Spine. 1994 May 15. 19(10):1138-43. [Medline].
Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine. 1996 Nov 15. 21(22):2594-602. [Medline].
Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine. 1996 Oct 1. 21(19):2251-4. [Medline].
Prather H, Hunt D. Conservative management of low back pain, part I. Sacroiliac joint pain. Dis Mon. 2004 Dec. 50(12):670-83. [Medline].
Liliang PC, Lu K, Liang CL, Tsai YD, Wang KW, Chen HJ. Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks. Pain Med. 2011 Apr. 12(4):565-70. [Medline].
Polly DW, Swofford J, Whang PG, et al. Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction. Int J Spine Surg. 2016 Aug 23. 10:28. [Medline]. [Full Text].
Sturesson B, Kools D, Pflugmacher R, Gasbarrini A, Prestamburgo D, Dengler J. Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management. Eur Spine J. 2016 May 14. [Medline].
Abdelgawad AA, Davey S, Salmon J, Gurusamy P, Kanlic E. Ilio-Sacral (IS) Screw Fixation for Sacral and Sacroiliac Joint (SIJ) Injuries in Children. J Pediatr Orthop. 2015 Feb 20. [Medline].
Harmon D, Alexiev V. Sonoanatomy and injection technique of the iliolumbar ligament. Pain Physician. 2011 Sep-Oct. 14(5):469-74. [Medline].
Chen CP, Lew HL, Tsai WC, Hung YT, Hsu CC. Ultrasound-guided injection techniques for the low back and hip joint. Am J Phys Med Rehabil. 2011 Oct. 90(10):860-7. [Medline].
Gupta S. Double needle technique: an alternative method for performing difficult sacroiliac joint injections. Pain Physician. 2011 May-Jun. 14(3):281-4. [Medline].
[Guideline] Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell MV, Buenaventura RM, et al. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations. Pain Physician. 2013 Apr. 16(2 Suppl):S49-S283. [Medline].
Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the Medicare population: 1994 to 2001. Spine. 2007 Jul 15. 32(16):1754-60. [Medline].
Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S. Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. J Orthop Sci. 2007 May. 12(3):274-80. [Medline].
Günaydin I, Pereira PL, Fritz J, König C, Kötter I. Magnetic resonance imaging guided corticosteroid injection of sacroiliac joints in patients with spondylarthropathy. Are multiple injections more beneficial?. Rheumatol Int. 2006 Mar. 26(5):396-400. [Medline].
Pulisetti D, Ebraheim NA. CT-guided sacroiliac joint injections. J Spinal Disord. 1999 Aug. 12(4):310-2. [Medline].
Chauhan G, Hehar P, Loomba V, Upadhyay A. A Randomized Controlled Trial of Fluoroscopically-Guided Sacroiliac Joint Injections: A Comparison of the Posteroanterior and Classical Oblique Techniques. Neurospine. 2018 Oct 7. [Medline].
Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002 Jan-Feb. 20(1):52-4. [Medline].
Vallejo R, Benyamin RM, Kramer J, Stanton G, Joseph NJ. Pulsed radiofrequency denervation for the treatment of sacroiliac joint syndrome. Pain Med. 2006 Sep-Oct. 7(5):429-34. [Medline].
Gevargez A, Groenemeyer D, Schirp S, Braun M. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint. Eur Radiol. 2002 Jun. 12(6):1360-5. [Medline].
Akbas M, Yegin A, Karsli B. Superior cluneal nerve entrapment eight years after decubitus surgery. Pain Pract. 2005 Dec. 5(4):364-6. [Medline].
Smuck M, Christensen S, Lee SS, Sagher O. An unusual cause of S1 radicular pain presenting as early phantom pain in a transfemoral amputee: a case report. Arch Phys Med Rehabil. 2008 Jan. 89(1):146-9. [Medline].
Yeoman W. The relation of arthritis of the sacroiliac joint to sciatica with analysis of 100 cases. Lancet. 1928. 2:1119-22.
Ziran BH, Heckman D, Smith WR. CT-guided stabilization for chronic sacroiliac pain: a preliminary report. J Trauma. 2007 Jul. 63(1):90-6. [Medline].

Media Gallery

Flouroscopically guided sacroiliac joint injection. Contrast seen throughout the joint.

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Author

Andrew L Sherman, MD, MS Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, Florida Society of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Gotlin, DO Associate Professor, Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine; Director of Orthopaedic and Sports Rehabilitation, Department of Orthopedic Surgery, The Continuum Center for Health and Healing, Beth Israel Medical Center

Robert Gotlin, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

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