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
Physician and Sports Medicine - VOL 30 - NO. 11 - NOVEMBER
Patrick/Fabere test - From: Fysioterapeutuddannelsen
- 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
- 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.
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