Assessing and diagnosing sacroiliac pain has long been a controversial topic. Even determining between the terms 'dysfunction' versus 'pain' is a controversial issue. Some authors define the term sacroiliac joint dysfunction as related to a specific pathology secondary to such things as spondyloarthropathy, infection, malignancy, or fracture (Freburger. 2001l. Other authors define sacroiliac joint dysfunction as related to biomechanical disorders including trauma, degenerative joint disease, joint laxity (Zelle, 2005)_ Still, others state that sacroiliac joint pain is considered to have biomechanical influences such as hypomobility or innorninate torsional asymmetry (Levangie, 1999 . The reader must decipher while reading an article, how the authors define sacroiliac joint dysfunction and/or pain disorders. Some people in the medical community dismiss the sacroiliac joint (SIJ) as a viable source of pain due to the lack of research in establishing the source of the pain (Hancock, 2007l. Authors argue that numerous tissues may refer pain to the sacroiliac region, therefore making it difficult to assess and provide effective treatment to the source of the pain (Freburger, 2001l. It can be argued that using a criterion reference standard, intra-articular SIJ blocks, patients have had relief of symptoms. So, what is the source of the pain? Is the pain caused by an asymmetry of the pelvis causing muscular imbalances, or muscular imbalances causing pelvic asymmetry? Another area of disagreement involves using diagnostic procedures that are not highly reliable or valid, and have low sensitivity and specificity. Determining these statistics is also difficult to assess since recent literature studying SIJ, rarely incorporate randomized, placebo controlled, double blinded studies or confirmatory sacroiliac blocks (Stubor, 2007l. Most authors agree that it becomes difficult to assess a given special test, since the criterion reference standard has not been demonstrated to be a 'gold standard' (Levangie, 1999 Hancock, 2007l. In one recent systematic review, the authors stated that SIJ blocks have been shown to have face validity. They may anesthetize the joint, but precautions need to be taken to ensure there are no extravasations to adjacent structures (Hansen, 2007l. Although, most SIJ experts agree that the reference standard is not an accepted one, a recent article states that there may be a current gold standard of diagnosing SIJ syndrome through fluoriscopically guided infiltration of local anesthesia leading to at least an 80% reduction in VAS scores (Weksler, 2007), There are generally three accepted categories of assessing sacroiliac joint pain. The three main categories of assessment and diagnosis include; (1) symmetry of bony landmarks, (2) assessing the movement of bony landmarks, and (3) pain provocation (Freburger, 2001l. To assist in determining the dysfunction, therapists may also obtain the patient's medical history, mechanism of injury, pain patterns and descriptions. The three preceding categories will be discussed in further detail and examined for reliability, sensitivity, and specificity and it will be determined which of these categories is used most frequently by practicing physical therapists in the orthopaedic clinic. How do clinicians assess and diagnose such a controversial topic when there is conflicting evidence? Since the literature is not definitive, clinicians are left deciding whether to use clinical experience, peer education, continuing education, or try to keep up with the most recent literature in the hopes of new breakthroughs in SIJ diagnoses. As evidence based practice is becoming more prevalent in the healthcare profession, should new therapists rely on the best available evidence that may be limited or clinical significance/experience that has not been confirmed as a valid measure by research evidence?
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Sacroiliac Joint Pain, Joint Pain and Dysfunction
Martinez, Sandra. "How Clinicians Assess and Diagnose Sacroiliac Joint Pain and Dysfunction Despite Conflicting Evidence -An Evidence Based Analysis and Physical Therapist Survey." (2014). http://digitalrepository.unm.edu/dpt/60