• C W Slipman, E B Sterenfeld, L H Chou, R Herzog, and E Vresilovic.
• Department of Rehabilitation Medicine, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
• Arch Phys Med Rehabil. 1998 Mar 1; 79 (3): 288-92.

ObjectiveTo determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS).DesignProspective constructive cohort study using sacroiliac joint block (SIJB) as the diagnostic gold standard.SettingTertiary care center.PatientsConsecutive patients describing low back pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ipsilateral sacral sulcus.InterventionsAll subjects underwent fluoroscopically guided SIJB.Main Outcome MeasuresResponse to SIJB was assessed with visual analog scale (VAS) ratings before and after the block. A reduction of the VAS rating by at least 80% was considered a positive response to SIJB.ResultsFifty consecutive patients met our criteria and underwent SIJB. Thirty patients had positive response to SIJB, making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determining the presence of SIJS is therefore 60%.ConclusionsOur results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.

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