From symptom to diagnosis | ISG Blocking

From symptom to diagnosis

A prerequisite for the diagnosis of ISG blockage is first of all a good anamnesis, which gives important information about the correct body region and functional disorder. After the inspection during which changes in the posture pattern are recognized and documented, the physical examination follows. There are a number of tests that allow the doctor to detect a blockage.

It is to be pointed out expressly that not all ISG tests are described here, but only at examples are shown how one can come relatively fast from the symptom to the diagnosis ISG blockage. Related to the ISG the next recommendable diagnostic step is the If the physician has collected first indications for a malfunction of the ISG by these tests, there are a number of possibilities to diagnose a blockage in the ISG. 2. joint play tests (Joint-play tests) In most cases the forerun positive side is treated.

• Hip-drop test (pelvic subsidence test)The physician stands behind the patient and asks the patient to alternately lower the side of the game leg, paying attention to the symmetry of the movements with regard to pelvic subsidence and pelvic rotation. Assessment:If the hip drop test is physiological (lowering of the pelvic halves in the same direction), there is a suspicion that the disorder is not in the lumbar-hip-ISG functional chain and the examination can be started directly on the next higher floor. This is the thoracolumbar transition (TLÜ).

  If the hip-drop test is reduced, a disorder may be present in the ISG, in the lumbar spine, or in the hip joint. A shortened iliotibial tractus or piriform muscle can also lead to a reduced hip drop test. If the test is reduced, the physician or therapist has further tests at his disposal to diagnose a disturbance in the functional chain of the lumbar spine – ISG hip.

• Patrick-Kubis-TestThe patient lies on his back and places his heel next to his opposite knee joint and performs a test movement by guiding the bent leg in abduction (spreading) and external rotation.

  The aim of this test is to test the extent of movement and the final feeling of the ISG. A prerequisite for this test is that hip joints, internal rotators, extensors and adductors are undisturbed.

• Preliminary TestThis test tests the joint clearance of both sacroiliac joints in motion. The physician stands behind the patient and palpates the posterior superior iliac spine (SIPS/rear iliac spine) from below.

  He then asks the patient to curl up from the head and perform a maximum trunk flexion. During this procedure, the advance and final position of the SIPS is observed. The movement of the sacrum in relation to the ilium in the sacroiliac joint is tested.

  With normal findings, the two iliac spines are at the same height at maximum trunk flexion, exactly as in the initial position. This means free movement in both sacroiliac joints. On the other hand, a one-sided elevation of the iliac spine at the end of maximum trunk flexion indicates that the corresponding ISG is blocked.

• Orientation tests

The patient lies in a supine position and the examiner palpates the sacroiliac joint space with his palpation finger.

The examiner then adjusts the patient’s hip flexion so that the ISG movement can be felt on the palpation finger. With a thrust along the longitudinal axis of the thigh, the final feeling of the ISG can be felt and assessed. This test should always be carried out in side to side comparison.

On the side where the joint play is restricted, there is a blockage. This test is performed in the prone position.The examiner stands in a stepping position and with one hand grasps the anterior superior iliac spine from the front, while palpating the ISG movement with the other hand. Then the examiner shakes the patient’s ilium with one hand while palpating the ISG-movement (shaking test).

Another possibility is to slowly pull the ilium backwards, i.e. towards the examiner. In doing so, one feels the extent of movement and the final feeling of the ISG (lifting test). This test should also be carried out in side comparison.

In all tests, the blocked side, the side with reduced joint play, is the side with reduced joint play and is treated. From a functional point of view, a distinction is made between pelvic torsion and ISG blockage. Pelvic flexion is actually a normal process during walking.

However, if functional disorders occur that are not caused by the ISG, but by the spine, for example, or the upper cervicals, pelvic flexion can also occur as a compensation mechanism. The pelvic contortion is characterized by: To treat pelvic torsion, the cause must be found and treated. It must be differentiated whether the cause lies in the joint or in the musculature.

Pelvic torsion and ISG blockage can also be present in combination.

• An asymmetry of the pelvic position, the position of the pubic branches and an indifference of the iliac spines on one side. The ISG blockage usually does not have these asymmetries.
• A positive leading phenomenon on the corresponding side, which disappears again after 20-30 seconds at maximum torso flexion. In case of a blockage, the forward motion remains constant
• Normal joint play (joint play)