Summary Sacroiliac Joint Dysfunction: SIJ Provocation/ Special tests
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Module
Physiotherapy
Institution
University Of The Witwatersrand (wits)
This summary provides a concise table of the SIJ provocation tests with images to illustrate the conduction of such tests. It also explains the movement of the sacrum which is essential in understanding the effect SI joint lesions. Furthermore it provides the symptoms and differential diagnoses not...
SIJ:
● Roles: provide stability and offset the load of the trunk on the lower limbs
● Movements occur as sacrum, innominates or innominates + sacrum
● Nutation: sacrum rotated forward relative to the ilia (innominates)
● Counternutation: sacrum rotated backwards relative to the iliac bones
● Form closure: the fit of the wedge-shaped sacrum between the ilia
● Force closure: the compressive force of muscles and ligaments
Sacroiliac Joint Dysfunction:
● Pain at SIJ caused by abnormal motion (hyper or hypo mobility) or malalignment of
the SIJ.
● Difficult to distinguish from other types of LBP.
● NB to rule out LBP and hip pathologies.
● Symptoms:
○ Localised pain over buttock
○ Sharp, stabbing and/or shooting pain which radiates down posterior thigh
(above knee)
○ Pain may mimic + be misdiagnosed as radicular pain (pinched nerve)
○ Pain with prolonged sitting
○ Local tenderness of posterior aspect of the SIJ – near the PSIS
○ Pain with mechanical stress of SIJ (e.g. forward flexion)
○ Absence of neuro deficit/ nerve root tension signs
○ Abnormal sacroiliac movement pattern
○ Pain with sitting/ ipsilateral side lying/ climbing stairs
, Sacroiliac Joint Provocation Tests:
Gillet’s test (Stork test):
● Pt flexes hip to 90
● Palpate both PSIS – shld be same level as ● Normal: PSIS drops below S2
S2 ● Dysfunctional (blocked or hypomobile): min or
● Palpate S2 and R SIJ w/ each thumb no drop of PSIS
Standing flexion: SI dysfunction
● Pt standing palpate BL PSIS ● Evaluate whether the movt of both PSIS are
● Ask pt to bend forward towards the midline symmetrical
● Normal: expect counter nutation at 60* of flex –
at that point the PSIS start to travel upwards
● Positive: side that PSIS moves further cranially
(hypomobility – less nutation btw sacrum and
ilium)
Compression test
Side-lying: Supine:
● Lie on asymptomatic side ● Tests: SI dysfunction and ligamentous
● Hips flexed to 45* instability
● Place hands on ant rim of ilium ● Fix of BL ASIS
● Apply 3-6 vertical thrusts of moderate velocity ● Direct oblique medial force through the ilia
of gradually increasing pressure ● Positive: reproduction of pain
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