Introduction:
The ilium and sacral bones of the pelvis are separated by the sacroiliac (SI) joint. The joint transfers weight from the upper body to the lower limbs. Stabilizing the joints are powerful muscles and ligaments. The sacroiliac joint can only move 0.07 inches to 0.15 inches in any direction. These joints may be the cause of up to 25 percent of cases of low back discomfort. One possible reason for axial low back pain is pain emanating from the sacroiliac joint. The sacroiliac joint may cause 25 percent of lower back discomfort. Sports, pregnancy, trauma, repetitive stress, and spinal surgery can all cause sacroiliac joint pain. This article aims to give a brief overview of sacroiliac joint discomfort and one of the diagnostic tests known as Gaenslen’s test.
What Can Be the Potential Causes of Sacroiliac Joint Pain?
Sacroiliac joint discomfort may result from either atraumatic or traumatic causes.
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Traumatic Reasons:
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Fractured pelvic rings.
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Soft tissue damage resulting from a buttock fall.
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Indirect injury from car crashes and sudden or frequent heavy lifting, straining, or torsion.
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Atraumatic Reasons:
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Spondyloarthritis (diseases characterized by inflammation in the spine and joints).
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Pregnancy.
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Enthesopathy (a disorder of the entheses, the connective tissues between bones and tendons or ligaments).
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Infections.
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Osteoarthritis (a degenerative disease that worsens over time, often resulting in chronic pain).
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Previous lumbar fusion.
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Scoliosis (sideways curvature of the spine).
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Differences in leg length.
What Is Gaenslen’s Test?
One of the five provocation tests that can be used to identify musculoskeletal problems and primary-chronic inflammation of the lumbar vertebrae and sacroiliac joint (SIJ) is Gaenslen's test, also known as Gaenslen's maneuver. The next tests are the Sacral Thrust Test, Thigh Thrust Test, Compression Test, and Distraction Test. The clinical prediction rule of three or more positive provocation tests that cause familiar back pain and non-centralization of pain is helpful in determining whether patients are more likely to have SIJ pain than other painful conditions. Composite SIJ test results are more accurately diagnostic when limited to back pain patients whose symptoms do not "centralize" after repeated movement testing. Since discogenic pain is extremely specific to centralization, positive SIJ test results in these individuals should be disregarded. In particular, the results of Gaenslen's test can reveal if an L4 nerve root lesion, hip pathology, pubic symphysis instability, or SIJ lesion is present or absent. Additionally, it may strain the femoral nerve. In patients with SIJ, this test is frequently performed to check for spondyloarthritis, sciatica, or other types of rheumatism.
Where Is Gaenslen’s Test Applied?
The physical examinations and screening process included the following inclusion criteria:
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From 20 to 70 years old
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Radiation to lower extremities or lower back or buttock pain present for at least six weeks before study enrollment.
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Pain or local tenderness in the SIJ region (the area extending inferiorly in the medial part of the PSIS (posterior superior iliac spine), that is, the joint between the sacrum and the ilium bones of the pelvis).
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Pain that worsens when bending laterally or backward.
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Positive findings on at least two pain-provocation tests (thigh thrust, Gaenslen, Yeoman, compression, distraction, and Newton tests) and one motion palpation test (Gillet and forward flexion tests).
Where Is Gaeslen’s Test Not Applicable?
If a patient fulfilled any of the following requirements, they were excluded:
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Being pregnant.
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Using nonsteroidal anti-inflammatory medications (NSAIDs) and physical treatment within 72 hours of the study period.
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Having had back surgery within the six months before the study period.
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Malignant tumors of the spine or pelvis, sacroiliitis (inflammation of the sacroiliac joint), and infections of the SIJ.
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Any fractures in the spine or pelvis; the presence of additional causes of low back pain (LBP), such as lumbar discopathy and spinal stenosis, as determined by MRI scanning and clinical examination.
How Is Gaeslen’s Test Performed?
A physical examination method called the Gaenslen test is used to look for hip joint pathologies such as hip joint arthritis or sacroiliac joint dysfunction. The Gaenslen test can be administered using these steps.
Goal: To determine whether the sacroiliac joint is the source of pain.
Candidate Position: Supine.
Conducting the Test: The tested limb is positioned in maximum flexion, and the non-tested leg is maintained in its extension. The examiner next applies flexion overpressure by placing one hand on the tested leg's anterior thigh and the other on the tested leg's knee (the posterior thigh, proximal to the knee, is an alternative position for patients with knee pathology). The extended leg can be lifted off the table to exert more force. If the test results in low back pain, it is considered positive.
Test Importance: The test works by applying pressure to the tissues on the back of the pelvis and causing movement at the sacroiliac joint. This test is not helpful in triangulating pain originating from the sacroiliac joint due to its limited diagnostic accuracy. Additionally, this test is beneficial for patients with hip pathology. Patients experiencing labral dysfunction or femoral acetabular impingement frequently find that the highly flexed hip position is unpleasant or uncomfortable.
What Is the Indication of Positive Outcome of the Gaenslen Test?
Hyperextension of the leg can result in motion in the sacroiliac joint, which can cause pain or exacerbate pre-existing pain. In this case, Gaenslen's test is deemed positive. An ipsilateral nerve root lesion or hip disease may also be the source of pain.
Gaenslen Accuracy Test:
The test's poor diagnostic usefulness can be attributed to its fair to poor specificity. In general, not enough study has been done on this exam to draw firm conclusions.
The Gaenslen's test has a sensitivity and specificity to evaluate the validity and reliability of motion palpation and pain provocation in comparison with the sacroiliac joint (SIJ) block as the gold-standard assessment approach of patients with sacroiliac joint dysfunction (SIJD).
Sensitivity: 61.5 %
Specificity: 33.3 %
The Mennell test, the Gaenslen test, and the thigh thrust test are used to assess the usefulness of sacroiliac pain provocation tests in cases of early active sacroiliitis. According to the study, sacroiliitis must be diagnosed if at least two out of three tests are positive.
Conclusion:
Diagnosing sacroiliac joint pain can be challenging. Similar to most mechanical low back pain, sacroiliac joint discomfort has a favorable prognosis. Patients should keep moving and avoid resting in bed. Exercises for stabilization and stretching are advantageous in addition to Gaeslen's exam. When verifying a diagnosis of SIJD, it is also advised to utilize motion palpation tests in addition to at least three provocation tests. Lastly, it is recommended to employ a combination of these tests in conjunction with other sources of data, such as patient history, symptoms, and imaging, to diagnose SIJD.
