Diagnostic performance of clinical tests for sacroiliac joint pain

Background: An updated review of the diagnostic clinical tests available for sacroiliac joint (SIJ) pain has yet to be undertaken. Objective: To evaluate the diagnostic performance of clinical tests for SIJ pain based on a systematic review. Methods: Five electronic databases were searched. Studies that examined the SIJ pain provocation tests with sensitivity and specificity data in patients (age >= 18 years) with non-specific, non-pregnancy related low back pain and/or buttock pain, with or without lower extremity symptoms, were selected. Studies related to SIJ dysfunction were excluded. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool has been used to evaluate the quality of all included studies. Results: Six studies were included in this systematic review and the QUADAS scores are similar for all selected studies. The diagnostic performance of most clinical tests was poor with low specificity (0.03-0.95), sensitivity (0.08-0.90), and positive likelihood ratio (0.3-1.4), when used in isolation. The thigh thrust is the most sensitive test (0.88), the distraction test is most specific (0.81), and the compression test has the strongest positive likelihood ratio (2.20). Three or more positive pain provocation tests showed optimal sensitivity (0.85-0.94) and specificity (0.78-0.79) values with high positive likelihood ratios (4.02-4.29). Conclusion: Pain location below the lumbosacral junction overlying the SIJ with at least three or more positive SIJ pain provocation tests (thigh thrust, distraction, and compression) should be considered for the clinical diagnosis of SIJ pain.