The value of medical history and physical examination in diagnosing sacroiliac joint pain.

STUDY DESIGN: This prospective study evaluated the diagnostic utility of historically accepted sacroiliac joint tests. A multidisciplinary expert panel recommended 12 of the "best" sacroiliac joint tests to be evaluated against a criterion standard of unequivocal gain relief after an intra-articular injection of local anesthetic into the sacroiliac joint.

OBJECTIVES: To identify a single sacroiliac joint test or ensemble of test that are sufficiently useful in diagnosing sacroiliac joint disorders to be clinically valuable.

SUMMARY OF BACKGROUND DATA: No previous research has been done to evaluate any physical test of sacroiliac joint pain against an accepted criterion standard.

METHODS: Historical data was obtained, and the 12 tests were performed by two examiners on 85 patients who subsequently underwent sacroiliac joint blocks. Ninety percent or more relief was considered a positive response, and less then 90% relief was considered a negative response.

RESULTS: There were 45 positive and 40 negative responses. No historical feature, none of the 12 sacroiliac joint tests, and no ensemble of these 12 tests demonstrated worthwhile diagnostic value.

CONCLUSION: Sacroiliac joint pain is resistant to identification by the historical and physical examination data from tests evaluated in this study.