Posterior Pelvic Pain Provocation Test: Difference between revisions
Kai A. Sigel (talk | contribs) (Removed two older videos and replaced them with a video with better audiovisual quality) |
Evan Thomas (talk | contribs) mNo edit summary |
||
Line 1: | Line 1: | ||
<div class="editorbox"> | <div class="editorbox"> | ||
'''Original Editors''' - | '''Original Editors''' - []User:Els Van Haver|Els Van Haver]] | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
</div> | </div> | ||
== Purpose == | == Purpose == | ||
The posterior pelvic pain provocation test is a pain provocation test used to determine the presence of [[Sacroiliac joint|sacroiliac dysfunction]]. It is used (often in pregnant women) to distinguish between pelvic girdle pain and low back pain.<ref name="Zeven">JK Freburger, DL Riddle. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001; 81:1135–1143</ref> <ref name="Laslett 2003">Laslett M, April CN, McDonald B, Young SB. Diagnosing Painful SI joints: A validation study of Mckenzie and SI provocation tests. Aust J Physiotherapy. 2003; 49:89-97.</ref> | The posterior pelvic pain provocation test is a pain provocation test used to determine the presence of [[Sacroiliac joint|sacroiliac dysfunction]]. It is used (often in pregnant women) to distinguish between pelvic girdle pain and low back pain.<ref name="Zeven">JK Freburger, DL Riddle. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001; 81:1135–1143</ref> <ref name="Laslett 2003">Laslett M, April CN, McDonald B, Young SB. Diagnosing Painful SI joints: A validation study of Mckenzie and SI provocation tests. Aust J Physiotherapy. 2003; 49:89-97.</ref><ref name="Laslett 2005">Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of SI joint pain: validity of individual provocation test and composites of tests. Manual Therapy 2005; 10:207-218.</ref> | ||
The test is | The test is also known as: | ||
*PPPP test | *PPPP test | ||
Line 16: | Line 16: | ||
*POSH test<br> | *POSH test<br> | ||
== Technique | == Technique == | ||
With the patient supine, the hip is flexed to 90° (with bended knee) to stretch the posterior structures. By applying axial pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly. One hand is placed beneath the sacrum to fixate its position while the other hand is used to apply a downward force to the femur. Broadhurst and Bond suggest to add hip adduction towards the midline while Laslett & Williams advise to avoid excessive adduction due to discomfort for the patient. <ref name="Elf">P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119</ref><ref name="Vijf">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="Tien">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><ref>Laslett M, Williams M. The reliability of selected pain provocation test for sacroiliac joint pathology. Spine 1998; 19(11): 1243-1249</ref> | With the patient supine, the hip is flexed to 90° (with bended knee) to stretch the posterior structures. By applying axial pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly. One hand is placed beneath the sacrum to fixate its position while the other hand is used to apply a downward force to the femur. Broadhurst and Bond suggest to add hip adduction towards the midline while Laslett & Williams advise to avoid excessive adduction due to discomfort for the patient. <ref name="Elf">P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119</ref><ref name="Vijf">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="Tien">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><ref>Laslett M, Williams M. The reliability of selected pain provocation test for sacroiliac joint pathology. Spine 1998; 19(11): 1243-1249</ref> | ||
Line 26: | Line 26: | ||
== 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.Several studies have compared existing pain provocation tests and concluded that not a single test but a [[Sacroiliac Joint Special Test Cluster|cluster of tests]] should be used to confirm diagnosis (grade A recommendation). There is level 1A evidence stating that a combination of positive tests (2 out of 4, 3 out of 5,…) produces a high likelihood ratio. Most commonly used tests with both sensitivity and specificity greater than 60% are: <ref name="Zes" /><ref name="Acht">BA Zelle, GS Gruen, S Brown, S George. Sacroiliac dysfunction: evolution and management. Clin J Pain. 2005; 21(5):446-455</ref><ref name="Negen">JK Freburger, DL Riddle. Using Published Evidence to Guide the Examination of the Sacroiliac Joint Region. Physical Therapy. 2001; 81(5):1135-1143</ref><ref name="Drie">M Laslett et al. Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 2005; 10:207-218</ref><ref name="Vijf" /><ref name="Zes">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</ref> | The gold standard to evaluate sacroiliac pain provocation tests is an intra-articular injection of a local anesthetic into the sacroiliac joint, under the guidance of radiological imaging.Several studies have compared existing pain provocation tests and concluded that not a single test but a [[Sacroiliac Joint Special Test Cluster|cluster of tests]] should be used to confirm diagnosis (grade A recommendation). There is level 1A evidence stating that a combination of positive tests (2 out of 4, 3 out of 5,…) produces a high likelihood ratio. Most commonly used tests with both sensitivity and specificity greater than 60% are: <ref name="Zes" /><ref name="Acht">BA Zelle, GS Gruen, S Brown, S George. Sacroiliac dysfunction: evolution and management. Clin J Pain. 2005; 21(5):446-455</ref><ref name="Negen">JK Freburger, DL Riddle. Using Published Evidence to Guide the Examination of the Sacroiliac Joint Region. Physical Therapy. 2001; 81(5):1135-1143</ref><ref name="Drie">M Laslett et al. Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 2005; 10:207-218</ref><ref name="Vijf" /><ref name="Zes">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</ref> | ||
*[[Distraction Test|Distraction test]] | *[[Distraction Test|Distraction test]] | ||
Line 34: | Line 34: | ||
*Sacral thrust test | *Sacral thrust test | ||
Laslett et al (2005) state that no further examination is | Laslett et al (2005) state that no further examination is wishful if both distraction and thigh thrust test provoke familiar pain because of their high individual sensitivity and specificity. If only one test or 2 other tests are positive, further testing is required to obtain a valid result.<ref name="Drie" /> | ||
The posterior pelvic pain provocation test has a high intertester reliability of 94,1 (kappa=0,64-0,82 and p<0,001) and a high degree of sensitivity (80-88%) and specificity (100%) in 2 studies of moderate to high methodological quality. Positive predictive value ranges from 25% to 70% and negative predictive value goes from 88% to 92%.<ref name="Vier">CC Yung, M Fredericson, M Smuck. Sacroiliac Joint Pain Syndrome in Active Patients - A Look Behind the Pain. The Physician and Sports Medicine 2002; 30(11)</ref><ref name="Zes" /><ref name="Drie" /><ref name="Zes" /><ref name="Vijf" /> <ref name="Mousaui">Mousaui SJ, Mousaui L, Alavizadeli A, Kamal S. Jrnl of Research in Rehabilitation Sciences; Vol 3, No.1(86).</ref> | The posterior pelvic pain provocation test has a high intertester reliability of 94,1 (kappa=0,64-0,82 and p<0,001) and a high degree of sensitivity (80-88%) and specificity (100%) in 2 studies of moderate to high methodological quality. Positive predictive value ranges from 25% to 70% and negative predictive value goes from 88% to 92%.<ref name="Vier">CC Yung, M Fredericson, M Smuck. Sacroiliac Joint Pain Syndrome in Active Patients - A Look Behind the Pain. The Physician and Sports Medicine 2002; 30(11)</ref><ref name="Zes" /><ref name="Drie" /><ref name="Zes" /><ref name="Vijf" /> <ref name="Mousaui">Mousaui SJ, Mousaui L, Alavizadeli A, Kamal S. Jrnl of Research in Rehabilitation Sciences; Vol 3, No.1(86).</ref> | ||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Assessment]][[Category:Pain]][[Category:Sacroiliac_Examination]][[Category:Vrije_Universiteit_Brussel_Project]][[Category:EIM_Residency_Project]][[Category:Special_Tests | [[Category:Assessment]][[Category:Pain]][[Category:Sacroiliac_Examination]][[Category:Vrije_Universiteit_Brussel_Project]][[Category:EIM_Residency_Project]][[Category:Special_Tests]] |
Revision as of 08:48, 6 December 2017
Original Editors - []User:Els Van Haver|Els Van Haver]]
Top Contributors - Els Van Haver, Kevin Savage, Laura Ritchie, Admin, Kim Jackson, Dan Rhon, Rachael Lowe, Aminat Abolade, WikiSysop, Tony Lowe, Evan Thomas, Tarina van der Stockt, Kai A. Sigel, Claire Knott, Wanda van Niekerk and Nicole Hills
Purpose[edit | edit source]
The posterior pelvic pain provocation test is a pain provocation test used to determine the presence of sacroiliac dysfunction. It is used (often in pregnant women) to distinguish between pelvic girdle pain and low back pain.[1] [2][3]
The test is also known as:
- PPPP test
- P4 test
- Thigh thrust test
- Posterior shear test
- POSH test
Technique[edit | edit source]
With the patient supine, the hip is flexed to 90° (with bended knee) to stretch the posterior structures. By applying axial pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly. One hand is placed beneath the sacrum to fixate its position while the other hand is used to apply a downward force to the femur. Broadhurst and Bond suggest to add hip adduction towards the midline while Laslett & Williams advise to avoid excessive adduction due to discomfort for the patient. [4][5][6][7]
The test is positive for pelvic girdle pain if the axial pressure provokes pain over the sacroiliac joint that is familiar to the patient.
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 the guidance of radiological imaging.Several studies have compared existing pain provocation tests and concluded that not a single test but a cluster of tests should be used to confirm diagnosis (grade A recommendation). There is level 1A evidence stating that a combination of positive tests (2 out of 4, 3 out of 5,…) produces a high likelihood ratio. Most commonly used tests with both sensitivity and specificity greater than 60% are: [9][10][11][12][5][9]
- Distraction test
- Compression test
- Thigh thrust test
- Gaenslen’s test
- Sacral thrust test
Laslett et al (2005) state that no further examination is wishful if both distraction and thigh thrust test provoke familiar pain because of their high individual sensitivity and specificity. If only one test or 2 other tests are positive, further testing is required to obtain a valid result.[12]
The posterior pelvic pain provocation test has a high intertester reliability of 94,1 (kappa=0,64-0,82 and p<0,001) and a high degree of sensitivity (80-88%) and specificity (100%) in 2 studies of moderate to high methodological quality. Positive predictive value ranges from 25% to 70% and negative predictive value goes from 88% to 92%.[13][9][12][9][5] [14]
References[edit | edit source]
- ↑ JK Freburger, DL Riddle. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001; 81:1135–1143
- ↑ Laslett M, April CN, McDonald B, Young SB. Diagnosing Painful SI joints: A validation study of Mckenzie and SI provocation tests. Aust J Physiotherapy. 2003; 49:89-97.
- ↑ Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of SI joint pain: validity of individual provocation test and composites of tests. Manual Therapy 2005; 10:207-218.
- ↑ P Vercellini. Chronic pelvic pain. Wiley-Blackwell 2011: 118-119
- ↑ 5.0 5.1 5.2 NA Broadhurst, MJ Bond. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spine Disorders. 1998; 11(4):341–345
- ↑ 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
- ↑ Laslett M, Williams M. The reliability of selected pain provocation test for sacroiliac joint pathology. Spine 1998; 19(11): 1243-1249
- ↑ Physiotutors. Thigh Thrust Test | Sacroiliac Joint Provocation. Available from: https://www.youtube.com/watch?v=id4GqQ82BiM
- ↑ 9.0 9.1 9.2 9.3 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
- ↑ BA Zelle, GS Gruen, S Brown, S George. Sacroiliac dysfunction: evolution and management. Clin J Pain. 2005; 21(5):446-455
- ↑ JK Freburger, DL Riddle. Using Published Evidence to Guide the Examination of the Sacroiliac Joint Region. Physical Therapy. 2001; 81(5):1135-1143
- ↑ 12.0 12.1 12.2 M Laslett et al. Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 2005; 10:207-218
- ↑ CC Yung, M Fredericson, M Smuck. Sacroiliac Joint Pain Syndrome in Active Patients - A Look Behind the Pain. The Physician and Sports Medicine 2002; 30(11)
- ↑ Mousaui SJ, Mousaui L, Alavizadeli A, Kamal S. Jrnl of Research in Rehabilitation Sciences; Vol 3, No.1(86).