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

Updated: Jan 16, 2019
  • Author: Andrew L Sherman, MD, MS; Chief Editor: Sherwin SW Ho, MD  more...
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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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