Sacral Thrust Test: Difference between revisions
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'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
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== Search Strategy == | == Search Strategy == | ||
Search engines PubMed, Web of Knowledge, Pedro<br>Keywords Posterior pelvic pain/Pelvic girdle pain/Sacroiliac pain + Provocation test* + Reliability/Sensitivity/Specificity/Validity | Search engines PubMed, Web of Knowledge, Pedro<br>Keywords Posterior pelvic pain/Pelvic girdle pain/Sacroiliac pain + Provocation test* + Reliability/Sensitivity/Specificity/Validity | ||
Searches have been performed between 28/10/2011 and 23/12/2011<br> | Searches have been performed between 28/10/2011 and 23/12/2011<br> | ||
== Purpose<br> == | == Purpose<br> == | ||
The sacral thrust test is a pain provocation test used to diagnose [[ | The sacral thrust test is a pain provocation test used to diagnose [[Sacroiliac joint dysfunction|sacroiliac dysfunction]]. One single positive test does not have high diagnostic accuracy but a combination with other sacroiliac pain provocation tests gives valid evidence for sacroiliac dysfunction. <br>The test is also known as: | ||
*Sacral compression test | *Sacral compression test | ||
*Downwards pressure test | *Downwards pressure test | ||
*Sacral spring test<br> | *Sacral spring test<br> | ||
== Technique<br> == | == Technique<br> == | ||
With the patient prone, the examiner applies an anteriorly directed pressure over the sacrum. One hand is placed directly on the sacrum and is being reinforced by the other hand. Purpose is to apply an anterior shear force to both sacroiliac joints since the ilia are fixed by the examination bench. The test is positive if pain is reproduced in the sacroiliac region. <ref name="Drie">NA Broadhurst, MJ Bond. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spine Disorders. 1998; 11(4):341–345</ref><ref name="Vier">P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119</ref> | With the patient prone, the examiner applies an anteriorly directed pressure over the sacrum. One hand is placed directly on the sacrum and is being reinforced by the other hand. Purpose is to apply an anterior shear force to both sacroiliac joints since the ilia are fixed by the examination bench. The test is positive if pain is reproduced in the sacroiliac region. <ref name="Drie">NA Broadhurst, MJ Bond. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spine Disorders. 1998; 11(4):341–345</ref><ref name="Vier">P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119</ref> | ||
<br> | <br> | ||
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== Evidence == | == Evidence == | ||
The gold standard to evaluate sacroiliac pain provocation tests is an intra-articular injection of a local anesthetic into the sacroiliac joint, under guidance of radiological imaging. <ref name="Vijf">M Laslett. Pain provocation sacroiliac joint tests: reliability and prevalence. In: Vleeming A, Mooney V, Snijders CJ, Dormann TA, Stoeckart R, editors. Movement, Stability and Low Back Pain: The Essential Role of the Pelvis. 1st ed. New York: Churchill Livingstone; 1997</ref> A specified level of pain reduction (70-90%) must be accomplished. There are however some problems related to the use of this gold standard: <ref name="Zes">P Van der Wurff, RHM Hagmeijer, W Meyne. Clinical tests of the sacroiliac joint. A systematic methodological review. Manual Therapy 2000; 5(2):89-96</ref> | The gold standard to evaluate sacroiliac pain provocation tests is an intra-articular injection of a local anesthetic into the sacroiliac joint, under guidance of radiological imaging. <ref name="Vijf">M Laslett. Pain provocation sacroiliac joint tests: reliability and prevalence. In: Vleeming A, Mooney V, Snijders CJ, Dormann TA, Stoeckart R, editors. Movement, Stability and Low Back Pain: The Essential Role of the Pelvis. 1st ed. New York: Churchill Livingstone; 1997</ref> A specified level of pain reduction (70-90%) must be accomplished. There are however some problems related to the use of this gold standard: <ref name="Zes">P Van der Wurff, RHM Hagmeijer, W Meyne. Clinical tests of the sacroiliac joint. A systematic methodological review. Manual Therapy 2000; 5(2):89-96</ref> | ||
*Only intra-articular pain sources are investigated | *Only intra-articular pain sources are investigated | ||
*Not all structures of the joint capsule are affected | *Not all structures of the joint capsule are affected | ||
*The use of a needle may cause or increase pain | *The use of a needle may cause or increase pain | ||
Many pain provocation tests for the sacroiliac region exist and have been subject to clinical research. There is however no consensus on how to endorse clinical decision-making. Grade A recommendation based on 3 level 1B studies identifies 4 to 5 tests with highest specifity and sensitivity among known sacroiliac pain provocation tests and acceptable intertester reliability to be included in the clinical examination: <ref name="Drie" /><ref name="Zes" /> | Many pain provocation tests for the sacroiliac region exist and have been subject to clinical research. There is however no consensus on how to endorse clinical decision-making. Grade A recommendation based on 3 level 1B studies identifies 4 to 5 tests with highest specifity and sensitivity among known sacroiliac pain provocation tests and acceptable intertester reliability to be included in the clinical examination: <ref name="Drie" /><ref name="Zes" /> | ||
*[[ | *[[Distraction Test|Distraction test]] | ||
*[[ | *[[SI compression test|Compression test]] | ||
*[[ | *[[Posterior pelvic pain provocation test|Thigh trust test]] | ||
*[[ | *[[Gaenslen Test|Gaenslen’s test]] | ||
*Sacral thrust test | *Sacral thrust test | ||
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{| width="150" border="1" cellpadding="1" cellspacing="1" | {| width="150" border="1" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
| PPV | | PPV | ||
| 56% | | 56% | ||
|- | |- | ||
| NPV | | NPV | ||
| 80% | | 80% | ||
|- | |- | ||
| Sensitivity | | Sensitivity | ||
| 63% | | 63% | ||
|- | |- | ||
| Specificity | | Specificity | ||
| 75% | | 75% | ||
|} | |} | ||
<br> | <br> | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1Zw2sdRS3tjKeudq7twTCzC__UpqLlOwUMnWW2wTF-7iBlEQxa|charset=UTF-8|short|max=10</rss> | <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1Zw2sdRS3tjKeudq7twTCzC__UpqLlOwUMnWW2wTF-7iBlEQxa|charset=UTF-8|short|max=10</rss> | ||
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== Resources == | |||
== References == | == References == | ||
<references /> | <references /> | ||
Revision as of 17:15, 24 December 2011
Original Editor - Els Van haver
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
Search engines PubMed, Web of Knowledge, Pedro
Keywords Posterior pelvic pain/Pelvic girdle pain/Sacroiliac pain + Provocation test* + Reliability/Sensitivity/Specificity/Validity
Searches have been performed between 28/10/2011 and 23/12/2011
Purpose
[edit | edit source]
The sacral thrust test is a pain provocation test used to diagnose sacroiliac dysfunction. One single positive test does not have high diagnostic accuracy but a combination with other sacroiliac pain provocation tests gives valid evidence for sacroiliac dysfunction.
The test is also known as:
- Sacral compression test
- Downwards pressure test
- Sacral spring test
Technique
[edit | edit source]
With the patient prone, the examiner applies an anteriorly directed pressure over the sacrum. One hand is placed directly on the sacrum and is being reinforced by the other hand. Purpose is to apply an anterior shear force to both sacroiliac joints since the ilia are fixed by the examination bench. The test is positive if pain is reproduced in the sacroiliac region. [1][2]
| [3] | [4] |
Evidence[edit | edit source]
The gold standard to evaluate sacroiliac pain provocation tests is an intra-articular injection of a local anesthetic into the sacroiliac joint, under guidance of radiological imaging. [5] A specified level of pain reduction (70-90%) must be accomplished. There are however some problems related to the use of this gold standard: [6]
- Only intra-articular pain sources are investigated
- Not all structures of the joint capsule are affected
- The use of a needle may cause or increase pain
Many pain provocation tests for the sacroiliac region exist and have been subject to clinical research. There is however no consensus on how to endorse clinical decision-making. Grade A recommendation based on 3 level 1B studies identifies 4 to 5 tests with highest specifity and sensitivity among known sacroiliac pain provocation tests and acceptable intertester reliability to be included in the clinical examination: [1][6]
- Distraction test
- Compression test
- Thigh trust test
- Gaenslen’s test
- Sacral thrust test
Lanslet et al (2005) state that no further examination is wishful if both distraction and thigh trust test provoke familiar pain. If only one test or 2 other tests are positive, further testing is required to obtain a valid result. Values for diagnostic utility can be found here.
The sacral thrust test has a moderate intertester reliability of 74 (kappa=0,52 and p<0,001), sensitivity of 63% and specificity of 75%. Positive predictive value is 56% and negative predictive value is 80%.
| PPV | 56% |
| NPV | 80% |
| Sensitivity | 63% |
| Specificity | 75% |
Recent Related Research (from Pubmed)[edit | edit source]
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Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 NA Broadhurst, MJ Bond. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spine Disorders. 1998; 11(4):341–345
- ↑ P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119
- ↑ Sacral Thrust Test. Available from: http://www.youtube.com/watch?v=k_folk7CzYg [last accessed 22/12/11]
- ↑ Sacral Thrust Test. Available from: http://www.youtube.com/watch?v=ZJ3kgS1fCM8 [last accessed 22/12/11]
- ↑ M Laslett. Pain provocation sacroiliac joint tests: reliability and prevalence. In: Vleeming A, Mooney V, Snijders CJ, Dormann TA, Stoeckart R, editors. Movement, Stability and Low Back Pain: The Essential Role of the Pelvis. 1st ed. New York: Churchill Livingstone; 1997
- ↑ 6.0 6.1 P Van der Wurff, RHM Hagmeijer, W Meyne. Clinical tests of the sacroiliac joint. A systematic methodological review. Manual Therapy 2000; 5(2):89-96
