Are SI Tests of any Predictive Value? No?

Reference:Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N 1996 The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine (21):22;2594-2602

Twelve of the ?best? SI joint tests chosen by an expert panel were evaluated against the ?gold standard? test of pain relief with an intra-articular injection of local anaesthetic into the SI joint.

Study Conclusion: ?Sacroiliac joint pain cannot be diagnosed from history or physical examination.
If the diagnosis is to be made, controlled diagnostic blocks are, at present, the only means to make that diagnosis.?

(In other words, Physical Therapy assessment for the SI joint is a ?waste of time?!)

Personal Comment:In that study they quote ?It remains possible that a major part of the so-called sacroiliac pathology is a pathology of the soft tissues surrounding the joint?. The ?gold standard? diagnostic block may be accurate for diagnosing pain within the joint (intra-articular), but NOT as accurate for diagnosing pain from the soft tissues surrounding the SI joint complex!

I hypothesize that many of the SI tests stress the soft-tissues surrounding the joint (i.e. the ligaments) and not the actual intra-articular structures.

Is it possible that the so-called ?gold standard? diagnostic blocks are not so ?gold? when it comes to diagnosing sacroiliac joint extra-articular pain? Although studies seem to indicate that various SI tests are in fact ?useless?, I will personally continue to perform them clinically and rely on them for determining the treatment for my patients with LBP.

Posted on: February 19, 2002


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