Is it useful to repeat sacroiliac joint provocative tests post-block?
Gordon Stanford1, Robert S Burnham
1Central Alberta Pain and Rehabilitation Institute, Lacombe Alberta, Canada.
Pain Medicine (Malden, Mass.)
|November 3, 2010
Summary
Repeating sacroiliac joint (SIJ) provocative tests after a diagnostic block is useful. Multiple positive pre-block SIJ tests aid diagnosis, but post-block normalization lacks diagnostic value.
Area of Science:
- Musculoskeletal Disorders
- Diagnostic Imaging
- Pain Management
Background:
- Sacroiliac joint (SIJ) pain is a common cause of low back pain.
- Diagnostic blocks are used to confirm SIJ as the pain source.
- The utility of repeating SIJ provocative tests after a block is not well-established.
Purpose of the Study:
- To assess the diagnostic value of repeating sacroiliac joint (SIJ) provocative tests after a diagnostic block.
- To determine if post-block normalization of SIJ tests aids in diagnosing SIJ pain.
Main Methods:
- Thirty-four patients with suspected unilateral SIJ pain were evaluated.
- Six SIJ provocative tests were performed before and 30 minutes after diagnostic SIJ blocks.
- Sensitivity, specificity, and likelihood ratios were calculated for pre-block positive tests and post-block normalized tests.
Main Results:
- Three or more positive pre-block SIJ provocative tests showed diagnostic utility (sensitivity 0.82, specificity 0.57, LR 1.9, P=0.04).
- Post-block normalization of the majority of SIJ provocative tests did not demonstrate significant diagnostic value (sensitivity 0.89, specificity 0.30, LR 1.3, P=0.3).
Conclusions:
- Multiple positive pre-block SIJ provocative tests are diagnostically useful for identifying SIJ pain.
- Post-block normalization of SIJ provocative tests does not reliably indicate SIJ pain origin.
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