SI Joint Pain Diagnostic Resources for Healthcare Providers

As part of any physical exam to determine whether the SI joint is the cause of a patient's pain, the clinical standard is to leverage Provocative Tests and Diagnostic Injections. Here are the symptoms to watch for during the exam.

Diagnosis of the SI joint as a Source of Symptoms

Sacroiliac (SI) joint disorders require appropriate interpretation of a patient’s history, clinical exam results, and imaging studies. Often hip pathology and lumbar pathology coexist with SI joint pathology.65

SI Joint Pain Symptoms

During physical examination, patients with SI joint disorders may exhibit any/all of the following symptoms:

  • Lower back pain
  • Sensation of lower extremity: pain, numbness, tingling, weakness
  • Pelvis / buttock pain
  • Hip / groin pain
  • Feeling of leg instability (buckling, giving way)
  • Disturbed sleep patterns due to pain
  • Disturbed sitting patterns (unable to sit for long periods, on one side)
  • Pain going from sitting to standing
Diagnosis Symptoms

What's Included in an SI Joint Exam

  • Differential diagnosis to rule out other sources of pain
    • Negative lumbar spine exam
    • Negative hip exam
  • While standing, have the patient point to the location of pain (Fortin Test)
  • Tenderness over SIJ sulcus
  • Single leg stance test may induce pain on supporting side
  • Positive active straight leg raise
  • Pain to palpation inferior to PSIS
  • Provocative Tests6,8,9
    • 3 of 5 positive (Distraction, Thigh Thrust, FABER, Compression, Gaenslen's)
  • Diagnostic injections of the SI joint
Provocative Test - Thigh Thrust (Diagnosis)

References

  1. Szadek, Karolina M, et al. “Diagnostic Validity of Criteria for Sacroiliac Joint Pain: a Systematic Review.” The Journal of Pain: Official Journal of the American Pain Society 10, no. 4 (April 2009): 354–368.

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