Gaenslen Test: Difference between revisions
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The patient is positioned in supine with the painful leg resting on the edge of the treatment table. The examiner sagitally flexes the non symptomatic side at the hip, with the knee also flexed, up to 90 degrees (Dreyfuss et al. 1996). The patient should hold the non-tested leg with both arms while the therapist stabilizes the pelvis and applies passive pressure to the tested leg to hold it in the hyperextended position. The therapist then applies more pressure so that the hip is put into further extension and adduction. A downward force is applied to the lower leg (symptomatic side) putting it into hyperextension at the hip, while a flexion based counterforce is applied to the flexed leg pushing it in the cephalad direction causing torque to the pelvis. (Cook & Hegedus (2013) Kokmeyer et al. 2002). | The patient is positioned in supine with the painful leg resting on the edge of the treatment table. The examiner sagitally flexes the non symptomatic side at the hip, with the knee also flexed, up to 90 degrees (Dreyfuss et al. 1996). The patient should hold the non-tested leg with both arms while the therapist stabilizes the pelvis and applies passive pressure to the tested leg to hold it in the hyperextended position. The therapist then applies more pressure so that the hip is put into further extension and adduction. A downward force is applied to the lower leg (symptomatic side) putting it into hyperextension at the hip, while a flexion based counterforce is applied to the flexed leg pushing it in the cephalad direction causing torque to the pelvis. (Cook & Hegedus (2013) Kokmeyer et al. 2002). | ||
If the patient’s normal pain is reproduced, the test is considered positive for SI joint lesion, hip pathology, pubic synthesis instability, or an L4 nerve root lesion. The femoral nerve may also be stressed by this test.<ref name="Dutton">fckLRfckLR&amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;gt; {{#ev:youtube|ZsUnEzC9vcQ|300}} &amp;amp;amp;amp;amp;amp;lt;ref&amp;amp;amp;amp;amp;amp;gt;online video, http://www.youtube.com/watch?v=ZsUnEzC9vcQ, last accessed 6/3/09</ref> | If the patient’s normal pain is reproduced, the test is considered positive for SI joint lesion, hip pathology, pubic synthesis instability, or an L4 nerve root lesion. The femoral nerve may also be stressed by this test.<ref name="Dutton">fckLRfckLR&amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;gt; {{#ev:youtube|ZsUnEzC9vcQ|300}} &amp;amp;amp;amp;amp;amp;amp;lt;ref&amp;amp;amp;amp;amp;amp;amp;gt;online video, http://www.youtube.com/watch?v=ZsUnEzC9vcQ, last accessed 6/3/09</ref> | ||
Test both sides if the patient complains of pain bilaterally. It is important to gain positive signs in at least 3 of the SIJ provocation tests before diagnosing SIJ pathology (Laslett et al. 2005) | |||
[[Image:Gaenslen's_test.jpg|left|331x219px]] | |||
{{#ev:youtube|Y2DrX6qy2yI|300}}<ref>Clinically Relevant Technologies, http://www.youtube.com/watch?v=Y2DrX6qy2yI; accessed May 2011</ref> | {{#ev:youtube|Y2DrX6qy2yI|300}}<ref>Clinically Relevant Technologies, http://www.youtube.com/watch?v=Y2DrX6qy2yI; accessed May 2011</ref> | ||
Revision as of 21:32, 20 January 2013
Original Editor - Jason Therrien and Katie Finley
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Purpose
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Gaenslen's Test is one of five provocation tests that can be used to detect musculoskeletal abnormalities and primary-chronic inflammation of the lumbar vertebrae and Sacroiliac joint. [1]
The other tests are the Distraction Test, Thigh Thrust Test, Compression Test and the Sacral Thrust Test (Laslett et al. 2005)
The clinical prediction rule of three or more provocation tests that provoke familiar back pain and non-centralisation of pain is a useful tool to identify the patients more likely to have SIJ pain than some other painful condition (Laslett, 2006). Diagnostic accuracy of composites of SIJ tests improves when interpretation is confined to back pain patients whose symptoms cannot be made to ‘centralise’ with repeated movement testing. Centralisation is highly specific to discogenic pain and positive SIJ tests in these patients should be ignored (Laslett, 2006).
Specifically, Gaenslen's test can indicate the presence or absence of a sacroiliac joint lesion, pubic symphysis instability, hip pathology, or an L4 nerve root lesion. It also stresses the femoral nerve. [2]
Technique
[edit | edit source]
The patient is positioned in supine with the painful leg resting on the edge of the treatment table. The examiner sagitally flexes the non symptomatic side at the hip, with the knee also flexed, up to 90 degrees (Dreyfuss et al. 1996). The patient should hold the non-tested leg with both arms while the therapist stabilizes the pelvis and applies passive pressure to the tested leg to hold it in the hyperextended position. The therapist then applies more pressure so that the hip is put into further extension and adduction. A downward force is applied to the lower leg (symptomatic side) putting it into hyperextension at the hip, while a flexion based counterforce is applied to the flexed leg pushing it in the cephalad direction causing torque to the pelvis. (Cook & Hegedus (2013) Kokmeyer et al. 2002).
If the patient’s normal pain is reproduced, the test is considered positive for SI joint lesion, hip pathology, pubic synthesis instability, or an L4 nerve root lesion. The femoral nerve may also be stressed by this test.[2]
Test both sides if the patient complains of pain bilaterally. It is important to gain positive signs in at least 3 of the SIJ provocation tests before diagnosing SIJ pathology (Laslett et al. 2005)
Evidence
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Diagnostic Accuracy:
The sensitivity and specifcity for the Gaenslen's test are 0.71 and 0.26, respectively. The negative likelihood ratio for this test is 1.12 while the positive likelihood ratios is 1.00. The reliability in terms of inter-examiner Kappa is 0.54-0.76. [4]
Resources[edit | edit source]
The value of sacroiliac pain provocation tests in early active sacroiliitis.
Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability.
Computed tomography in diagnosis of septic sacroiliitis: report of three cases.
Pyogenic infections of the sacro-iliac joint.
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ F. J. Gaenslen (1927). "Sacro-iliac arthrodesis: indications, author’s technic and end-results". Journal of the American Medical Association 86: 2031–2035.
- ↑ 2.0 2.1 Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2nd ed. New York: McGraw Hill, 2008. Cite error: Invalid
<ref>tag; name "Dutton" defined multiple times with different content - ↑ Clinically Relevant Technologies, http://www.youtube.com/watch?v=Y2DrX6qy2yI; accessed May 2011
- ↑ Flynn T, Cleland J, Whitman J. Users’ Guide to the Musculoskeletal Examination: Fundamentals for the Evidence-Based Clinician. Buckner, KY: Evidence in Motion, 2008.
