THE PREDICTIVE VALUE OF PROVOCATIVE SACROILIAC JOINT STRESS MANEUVERSIN THE DIAGNOSIS OF SACROILIAC JOINT SYNDROME

Objective: To determine the clinical validity of provocative sacroilia c joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint sy ndrome (SIJS). Design: Prospective constructive cohort study using sac roiliac joint block (SIJB) as the diagnostic gold standard. Setting: T ertiary care center. Patients: Consecutive patients describing low bac k pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ips ilateral sacral sulcus. Interventions: All subjects underwent fluorosc opically guided SIJB. Main Outcome Measures: Response to SIJB was asse ssed with visual analog scale (VAS) ratings before and after the block . A reduction of the VAS rating by at least 80% was considered a posit ive response to SIJB. Results: Fifty consecutive patients met our crit eria and underwent SIJB. Thirty patients had positive response to SIJB , making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determin ing the presence of SIJS is therefore 60%. Conclusions: Our results do not support the use of provocative SIJ maneuvers to confirm a diagnos is of SIJS. Rather, these physical examination techniques can, at best , enter SIJS into the differential diagnosis. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physi cal Medicine and Rehabilitation.