Stork test

Original Editors - Lauren Trehout

Top Contributors - Jetse De Proft, Lauren Trehout, Yvonne Yap, Adam Vallely Farrell and Rachael Lowe  

Purpose

There are a number of sacroiliac joint (SIJ) mobility tests used to assess movement or asymmetry of the SIJ.[1] SIJ dysfunction refers to misalignment or abnormal movement of the SIJ, which can cause pain in or around the SIJ.[2]

The Stork test, also known as the Gillet Test, assesses the movement of the SIJ between the innominate and sacrum through the clinician's palpation, which may be a useful test for clinical evaluation of a subject's ability to stabilize intrapelvic motion.[3]

Technique

The assessment of the Stork test involves palpation of the posterior superior iliac spine (PSIS). There are 2 phases to the Stork test: the stance phase and the hip flexion or swing phase.

To perform this test, the patient stands while the examiner palpates the posterior superior iliac spine (PSIS) with one thumb and palpates the base of the sacrum with the other thumb medial to the PSIS. The patient is then instructed to stand on one leg while pulling the hip of the side being palpated into 90° or more of hip flexion. The test is then repeated on the other side and compared bilaterally[4][5]. The examiner should compare each side for quality and amplitude of movement[6].


In a normally functioning pelvis, the pelvis of the side being palpated should rotate posteriorly, causing the PSIS to drop or move inferiorly. There should also be symmetry in amount of movement between both the left and right SIJ. The test is positive when the PSIS on the ipsilateral side (same side of the body) of the knee flexion moves minimally in the inferior direction, doesn’t move or is associated with pain. A positive test is an indication of sacroiliac joint hypomobility.[7]


Evidence

There is little evidence favoring that mechanical SIJ dysfunctions are related to the experience of back pain and referred pain. The range of motion in the SIJ is small, less than 4° of rotation and up to 1,6 mm of translation. It is hence difficult and doubtful to found differences in range of motion between the symptomatic and asymptomatic sides for patient with presumed SIJ pain.[3]

Several studies concluded that not a single test but a cluster of tests should be used to confirm diagnosis. The recommended SIJ Test Item Cluster are:[8]

  1. Distraction test
  2. Compression test
  3. Thigh thrust test
  4. Gaenslen’s test
  5. Sacral thrust test

The thigh thrust test, compression test, and three or more positive stressing tests showed discriminative power for diagnosing SIJ pain. 3 of 5 of the tests must be positive, whilst 1 of the 3 positive results must be Thigh Thrust or Compression.[9]


A positive Stork test (Gillet test), combined with other positive sacroiliac mobility tests, indicates an valid impairment of mobility of the sacroiliac joint (SIJ). Springing tests, by means of which a passive mobility ("joint play") is being tested, are most valuable in dysfunction diagnostics[10]. However, the clinical use of these clusters however has yet to been validated .Multiple studies confirm that these tests have no significance to determine SIJ dysfunction nor pain.[11][12][13].

1 study determined that the Stork test, together with the examination of irritation points and irritation points during functional testing could asses SIJ dysfunction.[14]

Reliability

  • The outcomes of individual mobility tests, including the Stork test, are not reliable and valid in diagnosing SIJ dysfunction.[12][15]
  • There is an average to high reliability in the assessment of the SIJ when a cluster of mobility and provocation tests are carried out[16]
  • Physical therapists can recognize an altered pattern of intrapelvic motion during the Stork Test, as well as distinguish between no relative movement and anterior rotation of the innominate bone during a Stork test[11]
  • Asymmetry in SIJ movement can also be found in asymptomatic subjects, having a .22 reliability. It is suggested not to rely solely on one test for diagnosis of SIJ dysfunction[17]

Hungerford et al. concluded that the ability of the physiotherapist to reliably palpate and recognize an altered pattern of intrapelvic motion during Stork Test on the support side was substantiated. The ability to distinguish between no relative movement and anterior rotation of the innominate bone during a load-bearing task was good. Further research is needed to determine the validity of this test for detecting pelvic girdle dysfunction.[3]

References

  1. Sturesson, Bengt Md, Uden Alf MD, PhD, Vleeming, Andry PhD., “A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test.”, Spine, 2000; 25(2):214. (2B)
  2. Daniel L Riddle, Janet K Freburger and North American Orthopaedic Rehabilitation Research Network, “Evaluation of the presence of sacroiliac joint region dysfunction using a combination of test: a multicenter intertester reliability study.” , 2002. Journal of the amercian Physical Therapy association, 2002; 87:879-887. (2B)
  3. 3.0 3.1 3.2 Barbara A Hungerford et al., “Evaluation of the ability of physical therapists to palpate intrapelvic motion with the stork test on the support side.”, Journal of American Physical therapy Association, 2007; 87:879-887. (2B)
  4. Dutton M. Orthopaedic examination, evaluation, and intervention. 2nd ed. New York: McGraw Hill, 2008.
  5. Konin J, Wiksten D, Isear J, Brader H. Special test for orthopedic examination. New Jersey: Slack, 2002.
  6. Lee D. The pelvic girdle: an approach to the examination and treatment of the lumbo-pelvic-hip region. 3rd ed. Edinburgh: Churchill Livingstone, 2004.
  7. Magee DJ. Orthopedic physical assessment. 5th ed. St. Louis: Saunders, 2008. (LOE 1A)
  8. KJ Stuber. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. J Can Chiropr Assoc. 2007; 51(1): 30-41 ( LOE 1A)
  9. Karolina M. Szadek, 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. (LOE 1A)
  10. Grgić V.; The sacroiliac joint dysfunction: clinical manifestations, diagnostics and manual therapy; Lijec Vjesn. 2005 Jan-Feb;127(1-2):30-5. (LOE 3A)
  11. 11.0 11.1 Hungerford B, Evaluation of the ability of physical therapists to palpate intrapelvic motion with the Stork test on the support side; Physical Therapy; 2007; Jul;87(7):879-87. (LOE 2A)
  12. 12.0 12.1 van der Wurff P, Hagmeijer RH, Meyne W., “Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability.”, Man Ther. 2000 Feb;5(1):30-6. (1A)
  13. Riddle DL, Freburger JK., “Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study.”, PHYS THER., 2002 Aug; 82(8):772-782. (2B)
  14. Galm R, Fröhling M, Rittmeister M, Schmitt E., “Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation.”, Eur Spine J. 1998;7(6):450-3. (1B)
  15. Wilco Meijne, Katinka van Neerbos, Geert Aufdemkampe, Peter van der Wurff d, Intraexaminer and interexaminer reliability of the Gillet test, Journal of Manipulative & Physiological Therapeutics Volume 22, Issue 1, Pages 4–9, January 1999. (LOE 1B)
  16. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A.,”Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint.”, Man Ther. 2009 Apr;14(2):213-21. (1B)
  17. Dreyfuss P, Dreyer S, Griffin J, Hoffman J, Walsh N. Positive sacroiliac screening test in asymptomatic adults. Spine. 1994;19(10):1138-1143.