This further supports the notion that three or more pain provocation tests can be used as a clinical prediction tool for SIJ pain. As the value of a negative likelihood ratio approaches zero, the test's power to rule out the disease in question approaches perfection. This was an expected finding given that the reference standard related to SIJ pain, not dysfunction. Note: A vertically directed force is applied to the midline of the sacrum at the apex of the curve of the sacrum, directed anteriorly, producing a posterior shearing force at the SIJs with the sacrum nutated. Receiver operator characteristic curves and areas under the curve were constructed for various composites. This presents the possibility that subjects may have been recorded as having a negative response to the first injection and so not passed on to the next confirmatory injection, which may have shown a positive response. In this paper, these two terms will be clearly differentiated. Notes: Prior probability (odds): 26% (0.3), POSITIVE TEST: Positive likelihood ratio: 4.16, 95% confidence interval: [2.10,8.21] Posterior probability (odds): 59% (1.4) 95% confidence interval: [42%,74%], NEGATIVE TEST: Negative likelihood ratio: 0.12, 95% confidence interval: [0.02,0.76] Posterior probability (odds): 4% (0.0) 95% confidence interval: [1%,21%], Odds = Probability / (1-Probability) +LR = Sensitivity / (1-Specificity) -LR = (1 - Sensitivity) / Specificity Posterior Odds = Prior Odds x LR. The sacroiliac joint: Anatomy, physiology and clinical significance. Slipman CW, Lipetz JS, Plastaras CT, et al. PhD thesis, Lund University, Malmo, Sweden,1999;2935. The prevalence of these disorders is reported as being about 20% in college students8 and between 8 and 16% in asymptomatic individuals9. SIJ dysfunction generally refers to aberrant position or movement of SIJ structures that may or may not result in pain. PMC Several studies have assessed inter-examiner reliability of tests for SIJ pain and dysfunction. Our apps are the ideal clinical companion for the busy clinician assisting you in finding the right technique for the right patient, providing clear instructional videos and descriptions, all based on the latest evidence. (95%CI), according to the independent variables. certain SIJ tests have been shown to have acceptable inter-rater reliability (Laslett and Williams, 1994; Kokmeyer et al., 2002), current evidence suggests that these tests alone cannot predict the results of a criterion standard such as diagnostic injection (Dreyfuss et al., 1996; Maigne et al., 1996; Slipman et al., 1998). A comparison of results appears in Table Table11. Mens JM, Snijders CJ, Stam HJ. Laslett M, Aprill CN, McDonald B. Provocation sacroiliac joint tests have validity in the diagnosis of sacroiliac joint pain. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain: A predictor of symptomatic discs and annular competence. Early studies reported mixed results on the inter-examiner reliability of pain provocation tests17,25,53,54, but subsequently these tests have been shown to possess acceptable levels of reliability provided that they are highly standardized12,13,19,50. Dreyfuss PH, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of history and physical examination in diagnosing sacroiliac joint pain. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. HHS Vulnerability Disclosure, Help This finding reinforces the idea that the manipulation technique is not specific to the SI region but impacts the lumbar spine as well90.. and transmitted securely. When 3 of 5 tests (distraction, thigh thrust, Gaenslen, sacral thrust, compression) are positive, it indicates SIJ dysfunction. Note: The pelvis is stressed with a torsion force by a superior/posterior force applied to the right knee and a posteriorly directed force applied to the left knee. Kilpikoski S, Airaksinen O, Kankaanpaa M, Leminen P, Videman T, Alen M. Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms: A systematic review. The Laslett cluster of SIJ pain provocation tests has the strongest evidence for noninvasive clinical testing. Spine 1995;20:31-7. Although debated throughout literature, it is generally accepted that 10-25% of patients who present with mechanical low back or buttock pain will have this pain secondary to sacroiliac joint pain. Mark Laslett, the author of the cluster, proposes a diagnostic algorithm to evaluate the outcome of each individual test. Note: Vertically oriented pressure is applied to the anterior superior iliac spinous processes directed posteriorly, distracting the sacroiliac joint. A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Werneke M, Hart DL, Cook D. A descriptive study of the centralization phenomenon: A prospective analysis. In: Vleeming A, Mooney V, Snijders CJ, Dormann TA, Stoeckart R, editors. Kokmeyer et al (2002)[9] found a kappa value of 0.70 and Arab et al (2009)[12] of 0.88. Gemmell HA, Jacobson BH. If you fail to provoke pain during the first two tests, continue with the third test. By running the validation tests, you can confirm that your hardware and settings are compatible with Failover . An alternate method of radiofrequency neurotomy of the sacroiliac joint: A pilot study of the effect on pain, function, and satisfaction. Then SIJ pain can be ruled out or is at least unlikely. Prone. Sacral Thrust Test Sacroiliac Joint Provocation Foley BS, Buschbacher RM. Le stockage ou l'accs technique est ncessaire pour crer des profils d'utilisateurs afin d'envoyer des publicits, ou pour suivre l'utilisateur sur un site web ou sur plusieurs sites web des fins de marketing similaires. The test leg is passively brought into full knee flexion, while the opposite hip remains in extension. Two approaches have been applied to determine the time at which normal faults became active. A number of studies have addressed the problem of poor reliability of individual palpation SIJ tests by assessing groups or clusters of tests with some success2932. Start with T10 and then go down (inferior angle of scapula is T6/7) b. Senior Research Fellow Auckland University of Technology, Auckland, New Zealand; Director of Clinical Services and Clinical Expert, PhysioSouth Ltd, Christchurch, New Zealand. Selectively infiltrating the putatively symptomatic joint completely relieves the patient of the pain. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Very few patients in the sample had SIJ pain or dysfunction. Objective To assess the diagnostic test accuracy of pain provocation tests for the sacroiliac joint. A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. While this may provide some encouragement to those accustomed to using these tests, it is hard to see how this can be of real value. A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions. The key tests (distraction, compression, thigh thrust, Gaenslen's, and sacral thrust) have been described in detail in previous publications19,5052 and are reproduced in Figures Figures115. Van der Wurff P, Buijs EJ, Groen GJ. Double-center observational study of minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: one-year results. Unable to load your collection due to an error, Unable to load your delegates due to an error. [2] Non-invasive clinical testing for SIJ pain rests on pain provocation tests that stress the SIJ structures and provoke the usual or familiar pain of which the patient complains. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. This group is dominated by clinicians with a surgical background who offer mainly surgical solutions to clinical issues. There is some support for the notion of an inflammatory condition within the joint either causing or associated with the pain, The joint is unstable through ligamentous laxity or tearing of the joint capsule. In tegenstelling tot Van der Wurff worden niet alle testen zonder meer uitgevoerd, maar bestaat hierin een zekere opbouw. Temple University Hospital - Main Campus. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). SI Joint Special Tests | Cluster of Laslett 848 views Jan 12, 2022 In this video, we explore the Cluster of Laslett, a test item cluster used in the diagnosis of SI joint dysfunction.. Le stockage ou l'accs technique qui est utilis exclusivement des fins statistiques anonymes. Overall, palpation tests for SIJ movement, position, and symmetry are compromised for a variety of reasons, not the least of which are the normal variations in form and the common finding of natural fusion3638. Laslett M, Williams M. The reliability of selected pain provocation tests for sacroiliac joint pathology. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. The examiner sagitally flexes the non symptomatic hip, while the knee also flexed (up to 90 degrees). The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. Part II: Clinical evaluation. Another common test battery to diagnose a symptomatic sacroiliac joint is the Cluster of van der Wurff. Note: The sacrum is fixated against the table with the left hand, and a vertically oriented force is applied through the line of the femur directed posteriorly, producing a posterior shearing force at the SIJ. The cluster includes: the Patrick Faber Test, the Gaenslen Test, CompressionDistraction Test, Anterior Shear Test, Log-Roll Test, and Distraction Test. This paper aims to clarify the difference between these clinical concepts and present current available evidence regarding diagnosis and treatment of SIJ disorders. Learn faster with spaced repetition. FABER / Patrick's test; Thigh thrust / femoral shear test; ASIS distraction (supine) Sacral compression (sidelying) Laslett et al report that the accuracy of detecting SI joint dysfunction is increased with at least 3 of the 5 tests are positive. 2007 Aug;12(3):e1. FOIA Overall, the rule of thumb is 2/4 positive tests are needed to diagnose a symptomatic SI joint. The Management of Valgus Extension Overload Syndrome Experienced with Hitting in a High School Baseball Player: A Case Report. Le Cluster de Laslett dcrit l'origine 6 tests provocateurs. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Some authors argue that if the patient achieves 50-75% pain relief, on 2 occasions with short and long acting nerve block, a diagnosis of SIJ dysfunction can be made, but with caution. The bacteriophage KPP-1 was found to be strictly lytic against K. variicola, a multidrug-resistant . . The negative likelihood ratio is 0.10, yielding a post-test probability of about 5%. The centralization phenomenon is a common clinical observation when low back patients are examined using the standardized test movements and sustained postures first described by McKenzie59. Nilsson-Wikmar L, Holm K, Oijerstedt R, Harms-Ringdahl K. Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: A randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Donelson R, Silva G, Murphy K. Centralisation phenomenon: Its usefulness in evaluating and treating referred pain. Simopoulos TT, Manchikanti L, Singh V, Gupta S, Hameed H, Diwan S, Cohen SP. Une autre batterie de tests courante pour diagnostiquer une articulation sacro-iliaque symptomatique est le Cluster de van der Wurff. [7] There is now thought that the gold standard of SIJ nerve block may not be the most appropriate[8] and so the IASP diagnostic criteria for SIJ pain no longer as valid as it once was. Sturesson B, Selvik G, Uden A. De cluster van Laslett bestaat uit vier testen. The site is secure. Gupta et al. In this author's opinion, the treatments with the most potential for reductions in pain and disability are exercises aimed at improvement in lumbopelvic stability and intra-articular steroid injections. It is unknown if provocation tests can reliably identify extra-articular SIJ sources of pain. The studies reviewed are largely in agreement, concluding that a multi-test regimen is an acceptable clinical tool to make reliable predictions of sacroiliac joint pain when compared to the gold standard. Vallejo R, Benyamin RM, Kramer J, Stanton G, Joseph NJ. Laslett et al[4] identified the TIC for SIJ dysfunction after the McKenzie evaluation to rule out discogenic pain. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Three pathways between the sacro-iliac joint and neural structures. The pain-provocation SIJ tests are reliable if performed in a highly standardized manner, using sufficient force to stress the SIJ. Bethesda, MD 20894, Web Policies This cluster of tests assesses the integrity of the joint structures, mobility of the SI joints, and tender, Straight Leg Raise Test and Well Leg Raise Test, Sacroiliac Joint Special Test: Sacral Thrust, Compression and Distraction Tests, Sacroiliac Joint Special Test: Mennell's Test, Sacroiliac Joint Special Test: Stork (Gillet) Test, Sacroiliac Joint Testing Item Cluster- Laslett's Cluster II. The Journal of Manual & Manipulative Therapy. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Nous utilisons des cookies pour optimiser notre site web et notre service. valuation de l'articulation sacro-iliaque. In the experimental study, there will be three different groups of participants. J Pain 2009;10:354-68. Pereira PL, Gunaydin I, Trubenbach J, et al. The McKenzie assessment consisted of flexion in standing, extension in standing, and right/left side bending, flexion in lying and extension in lying. With these factors in mind finding a method which is both cost-effective and has strong enough predictive values to accurately diagnose pathologies, thereby avoiding unnecessary cost and invasive procedures, and aiding in the correct treatment of patients. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Forst SL, Wheeler MT, Fortin JD, Vilensky JA. Test Item Cluster (TIC) is a group of special tests which are developed to facilitate clinical decision making by improving the diagnostic utility. Buchowski JM, Kebaish KM, Sinkov V, Cohen DB, Sieber AN, Kostuik JP. The coronavirus disease 2019 (COVID-19) pandemic, originating from Wuhan, China, is known to cause severe acute respiratory symptoms. The implications for lumbopelvic function and dysfunction. LLJM van Deursen, Patijn J, Ockhuysen AL, Vortman BJ. This is an example of why we need to review the literature to assess the methodological quality. Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: Inter-reader reliability and prevalence of abnormalities. DonTigny RL. You can increase the specificity when the patients symptoms dont centralize as described by McKenzie. Diagnosis of SIJ Pain Continue if 0 or 1 tests are positive Perform the Sacral Thrust test Outcome: Dagenais S, Haldeman S, Wooley JR. Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: A critical review of the literature. Calculation of the posterior probability from data provided by Gutke et al91 resulted in an 89% (95% CI 8393%) probability that those satisfying the rule would have SIJ pain. Werneke M, Hart DL. Some SIJ pain patients may be best treated by exercise, some by intra-articular corticosteroid or phenol injection, and some by other treatments such as manipulation or prolotherapy. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Mark Laslett, l'auteur du groupe, propose un algorithme de diagnostic pour valuer les rsultats de chaque test individuel. In addition, injectate may spread from a successful intra-articular injection to adjacent structures including the dorsal sacral foramina, the L5 spinal nerve and lumbosacral plexus84. The reliability of multi-test regimens with sacroiliac pain provocation tests. eCollection 2022. Intertester reliability for selected clinical tests of the sacroiliac joint. found the specifcity of the test to be 75% and the sensitivity to be 63% [12]. The first perspective proposes that the joint is malfunctioning in some manner and the word dysfunction is commonly used to encapsulate the complexity of aberrations believed to occur. Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain. It has a reported sensitivity of 88% and specificity of 78% for 2 or more positive tests. Gaenslen's Test ( Gaenslen's maneuver) is one of the five provocation tests that can be used to detect musculoskeletal abnormalities and primary-chronic inflammation of the lumbar vertebrae and Sacroiliac joint (SIJ). Study with Quizlet and memorize flashcards containing terms like Laslett cluster, Thigh thrust, Gaenslen's test and more. While these treatments could be studied separately, it may be preferable that the treatment arm of the study follow a sequence with an initial period of stabilization training followed by steroid injection for those patients not achieving a satisfactory outcome from exercise. Surgical debridement107 and fusion108 are more invasive but appear to offer a moderate chance of pain reduction and functional improvement in patients with confirmed SIJ pain unresponsive to more conservative interventions. If the same SIJCPR were applied to a cohort of women with pregnancy-related PGP, this proportion would likely be much higher. Gunaydin I, Pereira PL, Fritz J, Konig C, Kotter I. NO SI Joint Pain unlikely What about Gaenslen's test? Freburger JK, Riddle DL. Sensitivity and specificity are the key statistical measures used to estimate diagnostic accuracy and to calculate the likelihood ratios of a positive or negative test. A recent review of SIJ interventions concluded that there is limited evidence in support of diagnostic and therapeutic procedures for the SIJ106. Are less than 2 or even all tests negative? These studies were evaluated against the CEBM criteria for a diagnostic reference study in order to assess the methodological quality of the studies and to review the validity of the results and conclusions made by each study. Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. J Pain Res. Vincent-Smith B, Gibbons P. Inter-examiner and intra-examiner reliability of the standing flexion test. Fagan's nomogram from data derived from Laslett et al52, N=34. (Reproduction of pain), Pt supine with both legs extended. Waldron T, Rogers J. Letter to the Editor regarding a study titled "Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composite of tests" [Manual Therapy 10 (2005) 207-218]. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: A double-blind study. The technical storage or access that is used exclusively for statistical purposes. Clinical predictors of screening lumbar zygapophysial joint blocks: Development of clinical prediction rules. Inter-and intra-examiner reliability of palpation for sacroiliac joint dysfunction. If about 30% of patients with low back pain have pain of SIJ origin, and an individual patient has three or more positive provocation SIJ tests, there is a 59% chance that this patient will have SIJ pain. 2022 Dec 6;15:3729-3832. doi: 10.2147/JPR.S386879. Si vous ne parvenez pas provoquer de douleur lors des deux premiers tests, passez au troisime test. Pelvic pain in Maigne's syndromea multi-segmental . The practical value of this data is as follows. Rapidly Reversible Low Back Pain: An Evidence-Based Pathway to Widespread Recoveries and Savings. This site needs JavaScript to work properly. One of your hypotheses might be that your patients pain is originating in the SI joint. Interestingly, although the technique used in this study is described as affecting the SI region, it was lumbar hypomobility that entered the prediction model. SIJ pain cannot be diagnosed using nerve blocks because of its diffuse innervation44. Although Kokmeyer et al (2002)[9] used the same test as studies by Laslett et al (2003)[4] and van der Wurff et al (2006),[6] Arab et al (2009)[12] used only three provocation tests: FABERs, thigh thrust and resisted abduction. Movement, Stability and Lumbopelvic Pain: Integration of Research and Therapy. Chandrupatla RS, Shahidi B, Bruno K, Chen JL. 2002;25:42-8. Examiner places hip in 90 deg flexion and adduction. A similar trial conducted by Elden et al revealed that treatment with stabilizing exercises was superior to standard treatment and that acupuncture provided additional benefit94. Positive Outcome: The diagnosis of a painful SIJ is given for 3 or more positive tests out of 5 The SIJ as source of nociception is rejected if less than 3 tests are positive The technical storage or access that is used exclusively for anonymous statistical purposes. Werneke M, May S. The centralization phenomenon and fear-avoidance beliefs as prognostic factors for acute low back pain. The distraction test (testing right and left SIJ simultaneously). If symptoms exist above L5 and the patient has >3/5 positive SIJ provocation tests, I treat the lumbar spine and the SI joint. This is not in agreement with a review conducted by Simopoulos et al (2012), which concluded that sacroiliac joint blocks are valid as a gold standard, however based on the literature reviewed; there could be a false positive rate of 20%.[1]. Likelihood ratios are summary statistics derived from sensitivity and specificity values. Notes: Prior probability (odds): 32% (0.5), POSITIVE TEST: Positive likelihood ratio: 6.97, 95% confidence interval: [2.39,20] Posterior probability (odds): 77% (3.3) 95% confidence interval: [53%,91%], NEGATIVE TEST: Negative likelihood ratio: 0.10, 95% confidence interval: [0.02,0.68] Posterior probability (odds): 5% (0.0) 95% confidence interval: [1%,25%], Odds = Probability / (1-Probability) +LR = Sensitivity / (1 - Specificity) -LR = (1 - Sensitivity) / Specificity Posterior Odds = Prior Odds x LR. This group generally consists of clinicians with a pain medicine background who commonly accept the SIJ as a significant source of back and referred pain, but who deem only injections and neurotomy as viable treatment methods. Philadelphia, PA 19140 Description. The sample size is 34 as a result of removal of the 9 centralization cases from the calculation and the prevalence is higher at 32%. Le Cluster de Laslett est un outil utilis dans l'valuation de la lombalgie. Specifically, I explain and demonstrate the following special tests: thigh thrust, distraction, sacral thrust, and compression tests.INSTAGRAM | @thecatalystuniversity Follow me on Instagram @thecatalystuniversity for additional helpful content and for my more fun side: Pets, Workouts, Dragon Ball ZWEBSITE | https://www.thecatalystuniversity.com/SleepPhones | Need to Relax? Bogduk N. The anatomical basis for spinal pain syndromes. Prolotherapy has been recommended by some reports, but the quality of evidence is poor, and methods and subjects are heterogeneous105. Those tests were chosen due to its acceptable inter-rater reliability. Laslett's Cluster II Sacroiliac Joint Testing Item Cluster is a set of six physical tests used to assess and diagnose potential problems with the sacroiliac (SI) joints. It was found that the optimum number of positive tests is three or more positive tests51. Additionally, in patients presumed to have an SIJ source of pain, Sturesson16 found no difference in range of motion between the symptomatic and asymptomatic sides. Dreyfuss P, Dryer S, Griffin J, Hoffman J, Walsh N. Positive sacroiliac screening tests in asymptomatic adults. The purpose of this commentary is to clarify the conceptual distinction between these perceived anatomical and biomechanical abnormalities, i.e., SIJ dysfunction, and pain arising from the SIJ, and its relation to the common complaint of low back and referred pain into the buttock, pelvis, and lower extremity. Furthermore, if all 5 tests are negative, you can likely look at structures other that the SI joint. They reported that the cluster of these tests exhibited a sensitivity of 0.82, specificity of 0.88, + LR of 6.83, and - LR of 0.20. The likelihood ratio for a positive test (three or more SIJ tests provoke the patient's familiar pain) is 4.16 so the probability of . If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Le 5e test mentionn dans la littrature est le test de Gaenslen. Lee A, Gupta M, Boyinepally K, Stokey PJ, Ebraheim NA. Ikeda R. Innervation of the sacroiliac joint: Macroscopic and histological studies. Clustering individually unreliable tests may improve reliability but still lacks face validity. Mobile Apps For Heath Care. Si le troisime test est galement ngatif, continuez avec le test de la pousse sacre. Berthelot JM, Labat JJ, Le Goff B, Gouin F, Maugars Y. Post a Question. Eventually, Laslett proposes an algorithm comprising 4 provocative tests to identify the SI joint as the source of pain as the other two tests didn't have additional diagnostic value. Federal government websites often end in .gov or .mil. Cluster of Laslett Maria Figueroa Mayordomo Aim Aim SI Primary Nociception Facilitates clinical decision making 10-25% LBP or buttock pain secondary to SIJ pain Sensitivity: 0.88 Specificity: 0.78 Distraction Test SIJ dysfunction or sprain of the anterior SI ligaments Pressure Researchers should be aware that intra-articular SIJ pain is not a homogeneous subgroup of the low back pain population. Cibulka et al32 reported a sensitivity of 82% and specificity of 88% for three of four palpation-based tests (standing flexion, PSIS position in sitting, supine long sitting, and prone knee flexion). Stuge et al compared specific stabilization exercises with individualized physical therapy without stabilization exercises in post-partum women with PGP. Subjects. Sometimes just a single pressure is enough. Laslett's Cluster II: Sacroiliac Joint Pain Test-item Cluster Sacral Thrust Test Compression Test Distraction Test Thigh Thrust Test Gaenslen's Test Additional Pain Provocation Tests (not included in test ): Mennel's Test FABER (Patrick's) Test Additional Pain Provocation Cluster Van der Wurff et al. Levangie P. Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain.