Recognizing specific characteristics of nonspecific low back pain
Bernard TN, Kirkaldy-Willis WH. Clinical Orthopedics 1987;217:266–80
SI Joint Key Points:
- In a study of 1,293 patients with low back pain, 22.6% were diagnosed with sacroiliac joint syndrome.
- Study also found that well-recognized syndromes (herniated nucleus pulposus and lateral spinal stenosis) occurred in 27.3% of cases, whereas less-recognized syndromes (SI joint and posterior joint syndromes) occurred in 44.6% of cases.
- Coexisting lesions occurred in 33.5%, the most common combined syndromes include: posterior joint and SI joint as well as spondylolisthesis and SI joint.
Materials and Methods: The medical records of 1,293 patients treated for low back pain during the period of 1972-1984 were reviewed. The majority of the patients in the study were referred to the low back pain clinic after having failed initial treatment by a primary care physician.
Sacroiliac Joint Syndrome: Referred pain from the SI joint may also mimic radicular pain. Diagnostic signs include tenderness over the posterior superior iliac spine, limited SI joint motion, provocation of familiar pain with Patrick’s test or Gaenslen’s maneuver, and pain reproduction during SI joint injection. The absence of tension signs and lack of motor, reflex, or sensory deficits helps distinguish this syndrome from anterior nerve root compression lesions.
Results: Of the 336 cases of SI joint syndrome, 205 occurred alone. In 95% of the cases, manipulation (258) or injection (66) yielded excellent or good results. Manipulation was successful in only 65% of the SI joint syndromes with concomitant nerve root compression syndromes.
Discussion: Three concepts have emerged from this study to making the diagnosis of low back pain more specific: (1) distinguishing referred pain from radicular pain; (2) recognizing coexisting lesions; and (3) using radiographic investigations to refine the diagnosis.
Coexisting lesions occurred in 33.5% of 1293 patients. The most common combined syndromes were posterior joint and SI joint syndromes, herniated nucleus pulposus and lateral spinal stenosis, central and lateral spinal stenosis, satellite muscle trigger points, and spondylolisthesis with SI joint syndrome.
Conclusions: A review of 1,293 cases of low back pain revealed that referred pain syndromes occur nearly twice as often as radicular syndromes. SI joint and posterior joint syndromes were the most common referred pain syndrome.
