Common Symptoms Of SI Joint Dysfunction
- Dull ache below L5, often unilateral.
- Deep posterior pain—may radiate into groin or thigh
- Intolerance with sitting or lying on affected side
- Pain while climbing stairs or hills
Patient history and risk factors
- Notable fall, misstep, awkward lifting or twisting
- Previous lumbar fusion
- Anatomic variations (e.g. pelvic or leg asymmetry)
- Female, past pregnancy
When you see the following, the SI joint should be considered as a pain generator:
- Pain inferior to L5, especially if patient points near the posterior superior iliac spine (PSIS)(Fortin Finger Test)
- Negative neurological exam
- Sacral sulcus tenderness on palpation
- Three or more positive provocative maneuvers (At least one of the three tests must be the Compression or Thigh Thrust)
A fluoroscopically guided, intra-articular diagnostic injection with greater than 75% relief is recommended to help confirm the diagnosis. A repeat injection provides added confirmation.
SI Joint Provocative Maneuvers
After performing a general back exam to rule out other diagnoses, ask patients to point to the area of their pain. Repeated pointing near the posterior superior iliac spine (PSIS) is considered a positive sign of SI joint dysfunction. Confirm by assessing tenderness of the sacral sulcus on palpation, and then
progress to provocative maneuvers.
- If three or more provocative maneuvers reproduce the patient’s pain (a positive test), the patient is likely to have refractory SI Joint Pain.
- One of these maneuvers should be compression or thigh thrust.
- Diagnosis should then be confirmed via SI joint injection.
- To learn more about performing provocative maneuvers, contact a representative.
FABER (Flexion, Abduction, External, Rotation) Provocative Maneuver – Tensile force is applied to the anterior aspect of the SI joint.
Compression Provocative Maneuver – A vertically directed force is applied to the iliac crest directed towards the floor, i.e. transversely across the pelvis, compressing the SI joints.
Thigh Thrust Provocative Test – The sacrum is fixated against the table with the left hand and a vertically oriented force is applied through the line of the femur directed posteriorly.
Distraction Provocative Maneuver – Vertically oriented pressure is applied to the anterior superior iliac spine directed posteriorly, distracting the SI joint.