Part 3a is reserved for painful palpation sites.  Some of this information is empirical and not completely “evidenced-based”, but does have a major role in the chain of diagnostics.

1. Painful palpation over long dorsal ligament is key.

-Vleeming et al showed that the long dorsal ligament is tensed when the sacroiliac joint is counternutated and slackened when nutated.

-This ligament is especially painful in women with PPPP.

-Long dorsal ligament can be palpated directly caudal to PSIS as a taut superficial structure.

-“Long Dorsal Ligament Test” has been shown to have high sensitivity (80%) and specificity (96%).

-However, the same study also showed that experience is needed to palpate it accurately.

Tidbit:

-You may have heard of Fortin’s Finger Test, which has been described as a  “simple diagnostic measure to successfully identify patients with sacroiliac joint dysfunction”.

-Keep in mind that this was published in 1997 and there has been other research that are more valid other than combination of Fortin’s Finger Test followed by Patrick’s Test. You can decide yourself by reading here and here.

-Nevertheless, painful palpation over LDL and the “Fortin Finger Test” together is very applicable.

2. Painful ASIS on involved side supine

-The patient should notice a discernible difference in tenderness with A/P pressure on the ASIS in supine.  This can be re-checked after the manual treatment approach (whatever you choose or you can refer back to picture from prior post here) to determine a change immediately in tenderness intensity.  This is a quick clinical approach to assess change other than pain rating scale.

-To me, this is the most solid “test” on this post for a screen and firsthand response of improvement for the patient.

-This is similiar to ASIS distraction test but you are assessing for response to the anterior aspect of the ilium rather than posteriorly.  Pressure is also in an anterior-posterior manner, rather than posterior-lateral as with the ASIS distraction method.

What are your thoughts of this series of painful palpation sites?  Even though it is low-level evidence, do you agree with the above locations?

Vleeming, et al.  The function of the long dorsal sacroiliac ligament: Its implications for understanding low back pain. Spine. 1996. 1;21(5):556-62.

Fortin JD, The Fortin finger test: an indicator of sacroiliac pain. Am J Orthop.  1997 Jul;26(7):477-80.

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