Learning outcome
- Pain associated with posterior pelvic tilt
- Sacroiliac joint arthritis
- Stable pelvic fracture
Special tests
- Sacroiliac joint compression test
- Sacroiliac joint distraction test
- Knee-to-shoulder test
- Patrick test (FABER)
- Posterior Pelvic Pain Provocation (P4) test
- Gaenslen test
- Examination with regard to stable pelvic fracture
Case 4
You are working as an intern doctor (LIS 1) at a general practitioner's office. The next patient is a 23-year-old man. He has been on sick leave from work at COOP for 2 months due to low, unilateral lower back pain without radiation. He is now 50% on sick leave. He wakes up early in the morning with pain and stiffness in the lower right part of his back, which improves with movement and within half an hour gets better so that he can go to work. The patient requests an extension of sick leave. He feels that he will not be able to handle the tasks at work, sitting at the cash register and performing miscellaneous tasks in the warehouse.
Pelvic examination
Perform an examination of the pelvic joints.
Inspection of the pelvis
Active movement of the pelvis
Iliosacral joint tests
Clinical findings
- You find a positive test for 'pressure against the sacrum in prone position' and 'P4 (Posterior Pelvic Pain Provocation)' during the clinical examination.
- In these examinations, the patient reports increased pain in the same area where he usually feels pain.
- Do you have enough information in the medical history and in the findings from the clinical examination to make the diagnosis?
What is wrong with the patient?
The patient has right-sided iliosacral joint arthritis.