Clinical Diagnostic Tests for Sacroiliac Joint Dysfunction and Pain: A Systematic Review of Diagnostic Accuracy Studies
TL;DR
There isn't a single clinical test that can accurately identify SIJ dysfunction on its own and it is necessary to conduct additional high-quality diagnostic accuracy investigations using defined reference standards.
Abstract
Background: Sacroiliac joint dysfunction is the one of the commonest conditions which leads to low back pain. However, due to its complex anatomy and biomechanics its diagnosis is quite difficult. Previous literature although recommended some clinical diagnostic tests but there accuracy is still unclear. Therefore, the aim of present review was to identify the most reliable clinical diagnostic test tool in order to assess sacroiliac joint dysfunction. Methodology: Three databases (PubMed, Cochrane library and PEDRO) was used to search the relevant articles. Various keywords related to sacroiliac joint dysfunctions and clinical/pain provocation test was used by using Boolean operators (AND/OR). The full text articles were taken from inception to till 2026. The included studies methodological quality was checked on the basis of QADAS-2 risk of bias tool. Results: Eleven studies satisfied the requirements for inclusion. The most often studied tests were those that provoked pain, such as the thigh thrust, compression, distraction, FABER, and Gaenslen tests. With sensitivity ranging from 53% to 88% and specificity ranging from 16% to 81%, individual tests showed inconsistent diagnostic accuracy. With sensitivity ranging from 85% to 91% and specificity ranging from 76% to 82%, clusters of three or more positive provocation tests consistently showed improved diagnostic accuracy. Motion palpation tests demonstrated higher variability and less diagnostic value. The majority of the examined studies showed a low-to-moderate risk Conclusion: There isn't a single clinical test that can accurately identify SIJ dysfunction on its own. Pain provocation test clusters offer the best diagnostic precision and ought to be used in standard clinical evaluation. It is necessary to conduct additional high-quality diagnostic accuracy investigations using defined reference standards.