Session Time: 2:30pm-3:15pm
Location: Research Hub - Live Theater
Disclosures: Reza Ehsanian, MD, PhD: Nothing to disclose
Objective: Determine the diagnostic validity of sacroiliac joint physical exam maneuvers using anesthetic intra-articular injection as a reference standard.
Design: Prospective cohort study.
Setting: Academic outpatient surgical center.
Participants: Thirty-five participants referred for sacroiliac joint injection.
Interventions: Fluoroscopically guided sacroiliac joint intra-articular injection of 1cc of 2% lidocaine and 1cc of triamcinolone 40mg.
Main Outcome Measures: Pain was assessed via a 0-10 Numerical Rating Scale in response to six physical exam maneuvers (Thigh thrust, Gaenslen’s, FABER, Distraction, Compression, and Sacral Thrust) performed pre-injection and post-injection. The results of these were evaluated singly and in combinations for diagnostic power in relation to a positive anesthetic response (> 80% relief) to the injection.
Results: There was no statistically or clinically significant association of a single or combination of physical exam maneuvers (PEMs) to positive anesthetic response. No single PEM had a positive likelihood ratio of greater than 1.58. Distraction test had the highest likelihood ratio of 1.58 for any single PEM, and was also the most sensitive (0.67; 95% CI 0.35-0.88) and specific (0.58; 95% CI 0.39-0.75) single PEM. Increasing the number of positive PEMs did not improve the diagnostic power. The highest likelihood ratio of PEMs in combination was only 1.2, which was for > 2 PEMs. There was a corresponding negative predictive value 0 (95% CI 0-0.18) when all PEMs were negative.
Conclusions: In this patient cohort, PEMs to identify intra-articular SIJ pain did not demonstrate diagnostic value when compared to the reference standard of an intra-articular injection with anesthetic.
Level of Evidence: Level II
To cite this abstract in AMA style:Ehsanian R, Schneider B, Rosati R, Huynh L, Levin J, Kennedy DJ. Prospective Study Comparing Physical Exam Maneuvers to Intra-articular Anesthetic Injection in the Diagnosis of Sacroiliac Joint Pathology [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/prospective-study-comparing-physical-exam-maneuvers-to-intra-articular-anesthetic-injection-in-the-diagnosis-of-sacroiliac-joint-pathology/. Accessed December 3, 2023.
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