Which tests are performed in the physical exam prior to sacroiliac (SI) joint injection?

Updated: Feb 16, 2021
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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The Gillette test is done with the patient in the standing position. The patient stands on one leg while flexing the opposite hip and knee into the chest. Motion of the SI joint is assessed by placing one thumb under the posterior superior iliac spine (PSIS) on the side of hip flexion, with the other thumb in the midline at the S2 level. Normally, the thumb under the PSIS drops inferiorly and laterally with hip flexion. Restriction is indicated by decreased motion compared to the normal side.

In the Fortin finger test, the patient points to the area of pain with one finger. The result is positive if the site of pain is within 1 cm of the PSIS, generally inferomedially.

The Patrick test or Faber maneuver involves flexion, abduction, and external rotation of the hip. The patient lies supine, with the heel of the tested side placed on the opposite knee. Pressure is put on the flexed knee and the opposite anterior superior iliac spine (ASIS) area. The  test result is positive for SI dysfunction if pain is elicited in the SI joint area. The sensitivity of this test in predicting response from SI joint injection is reportedly low (57%), [18, 19, 20]  whereas others have reported 77% sensitivity and 100% specificity [21] ; however, the accuracy of these studies has been questioned. [22]

In the Gaenslen test, the patient is supine. The hip and knee are maximally flexed toward the trunk, and the opposite leg is extended. Pressure is applied to the flexed extremity. The finding is positive if pain is felt across the SI joint. This test was found to be 68% sensitive and 35% specific. [23, 24]  However, the validity of this test has also been questioned. [25]

In the compression test, the patient lies on one side. The examiner applies pressure on one pelvic brim in the direction of the other. A positive result is pain across the SI joint.

In the Van Durson standing flexion test, the patient is standing with the examiner behind him. The examiner’s thumbs are placed just below each PSIS. The patient flexes the trunk forward without bending the knees. A positive sign is asymmetric motion.

In the Piedallu seated flexion test, the patient is seated with the examiner behind him. The examiner’s thumbs are placed just below the PSIS. The patient flexes the trunk forward. A positive result is asymmetry of motion.

An individual positive clinical test result may not prove to be indicative of SI joint pain. However, if three clinical tests reveal positive results, the likelihood that the pain originates from the SI joint is greatly increased. [26]

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