02/16/2024
A Diagnostic Scoring System for Sacroiliac Joint (SIJ) Pain Originating from the Posterior Ligament 💡
👉 According to the a brand-new german study summarizing the recommendations from a new clinical guideline published by the German Spine Society, there is conflicting evidence as to whether the combination of multiple clinical provocation tests (≥3 tests) can predict outcome of intra-articular SI joint injection. (Quality of evidence: very low). (https://journals.sagepub.com/doi/10.1177/21925682241230922)
🤷One - among other -reasons for this low diagnostic accuracy might be the non-consideration of pain arising from the ligamentous apparatus surrounding the SI joint (https://pubmed.ncbi.nlm.nih.gov/19101212/, https://pubmed.ncbi.nlm.nih.gov/18259783/)
👉 In 2016, Kurosawa and colleagues developed a diagnostic scoring system to differentiate sacroiliac joint (SIJ) pain originating from the posterior ligament (criteria: Pain improved by 70% after a periarticular SIJ injection. Other types of injections were not effective) from lumbar disorders (lumbar disc herniation and lumbar spinal canal stenosis, criteria: only surgical cases, physical and MRI findings; significant improvement 3 months after surgery). (https://pubmed.ncbi.nlm.nih.gov/28204687/)
The biggest differentiators between lumbar spine disorders and SIJ pain originating from the posterior ligament were six items as follows:
1️⃣ the posterior superior iliac spine (PSIS) area indicated using the one-finger test,
2️⃣ groin pain,
3️⃣ pain while sitting on a chair with-out back rest,
4️⃣ SIJ positive shear test,
5️⃣ PSIS tenderness, and
6️⃣ sacrotuberous ligament (STL) tenderness (s. figure).
👉These six items are used as the SIJ scoring system. The sum of the risk scores for each patient ranged from 0 to 9. It has a sensitivity of 90.3% and specificity of 86.4% for a positivity cutoff point of 4 or higher.
⭕ But CAVE: Additional studies are needed to determine if this scoring system can distinguish SIJ related pain from non-specific lower back and buttocks pain and from systemic pain syndrome, such as fibromyalgia.
📸 Illustration: https://link.springer.com/chapter/10.1007/978-981-33-6204-8_6
