Palpation

Diagnosis of Sacroiliac Joint Pain: Validity of Individual Provocation Tests and Composites of Tests

By Frank M. Painter|December 14, 2021|Palpation|

Diagnosis of Sacroiliac Joint Pain: Validity of Individual Provocation Tests and Composites of Tests

SOURCE: Manual Therapy 2005 (Aug); 10 (3): 207–218

Mark Laslett, Charles N. Aprill, Barry McDonald, Sharon B. Young

Department of Health and Society,
Linköpings Universitet,
Linköping, Sweden.

Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard.

In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842.

In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.

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Validity of Palpation of the C1 Transverse Process

By Frank M. Painter|August 5, 2015|Palpation, Validity Study|

Validity of Palpation of the C1 Transverse Process: Comparison with a Radiographic Reference Standard

The Chiro.Org Blog

J Can Chiropr Assoc 2015 (Jun); 59 (2): 91–100 ~ FULL TEXT

Robert Cooperstein,MA, DC, Morgan Young,DC, and
Makani Lew,DC

Palmer West College of Chiropractic
Palmer Center for Chiropractic Research

Primary goal: to determine the validity of C1 transverse process (TVP) palpation compared to an imaging reference standard.

METHODS: Radiopaque markers were affixed to the skin at the putative location of the C1 TVPs in 21 participants receiving APOM radiographs. The radiographic vertical distances from the marker to the C1 TVP, mastoid process, and C2 TVP were evaluated to determine palpatory accuracy.

RESULTS: Interexaminer agreement for radiometric analysis was “excellent.” Stringent accuracy (marker placed ±4mm from the most lateral projection of the C1 TVP) = 57.1%; expansive accuracy (marker placed closer to contiguous structures) = 90.5%. Mean Absolute Deviation (MAD) = 4.34 (3.65, 5.03) mm; root-mean-squared error = 5.40mm.

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The Accuracy of Manual Diagnosis

By Frank M. Painter|January 14, 2014|Manual Diagnosis, Motion Palpation, Palpation, Spinal Joint Pain|

The Accuracy of Manual Diagnosis for Cervical Zygapophysial Joint Pain Syndromes

The Chiro.Org Blog

SOURCE: Med J Aust. 1988 (Mar 7); 148 (5): 233–236

Jull G, Bogduk N, Marsland A.

University of Queensland, St Lucia.

The ability of a manipulative therapist to diagnose symptomatic cervical zygapophysial joint syndromes accurately was evaluated in a series of 20 patients. In 11 patients the presence, or absence, of a symptomatic joint was established by means of radiologically-controlled diagnostic nerve blocks. These patients were assessed by the manipulative therapist, without knowledge of the medical diagnosis. Another nine patients were first seen by the manipulative therapist whose diagnosis was then evaluated by means of diagnostic blocks.

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