Posterior Pelvic Exam

From: Yung C. Chen, MD; Michael Fredericson, MD; Matthew Smuck, MD; Sacroiliac Joint Pain Syndrome in Active Patients - A Look Behind the Pain; The Physician and Sports Medicine - VOL 30 - NO. 11 - NOVEMBER 2002

• Posterior pelvic pain provocation test (thigh thrust). With the patient supine, the hip is flexed to 90° and the knee is bent (figure 1). The examiner applies posterior shearing stress to the SIJ through the femur. Excessive adduction of the hip is avoided, as combined flexion and adduction is normally painful.
• Gaenslen's sign. With the patient supine, the hip is maximally flexed on one side, and the opposite hip is extended (figure 2). This maneuver stresses both SIJs simultaneously by counterrotation at the extreme range of motion. This test also stresses the hip joints and stretches the femoral nerve on the side of hip extension, so care should be taken to ensure normal hip findings and the absence of neurologic conditions affecting the femoral nerve.
• Patrick's test. This test stresses the hip and SIJ by flexion, abduction, and external rotation of the hip. A positive test reproduces back or buttock pain, whereas groin pain is more indicative of hip joint pathology.
• Sacroiliac shear test. With the patient prone, the palm of the examiner's hand is placed over the posterior iliac wing, and an inferiorly directed thrust produces a shearing force across the SIJ.
• Compression test. With the patient in a side-lying position, downward pressure is applied to the uppermost iliac crest, directed toward the opposite iliac crest. It is intended to stretch the posterior sacroiliac ligaments and compress the anterior SIJ.
• Distraction test (gapping). With the patient supine, a posterior and lateral force is applied to both anterior superior iliac spines to stretch the anterior sacroiliac ligaments and synovium.

Patrick/Fabere test - From: Fysioterapeutuddannelsen i Esbjerg.

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