Diagnosis of<unk>  is a clinical diagnosis determined by history and physical exam findings in conjunction with radiological findings. History and Physical Exam Patients often will present to their health care provider with the aforementioned signs and symptoms. In addition, providers can ask patients targeted questions to obtain additional information regarding their pelvic pain. Questions related to specific movements such as climbing stairs, turning in bed, changes in gait and stride length, pain with carrying any weight, or difficulty urinating or defecating should be discussed when obtaining a history of present illness from these patients. Manual testing by a healthcare professional can also be used. The patient is placed in various positions and pressure is applied in such a way that it provokes pain and maybe movement in the<unk> . Physical exam special tests include point tenderness when the<unk><unk>  is palpated, a positive Trendelenburg sign, and a positive Patricks Faber test. Practitioners may also appreciate a palpable gap when examining the mons<unk> . Other observations may include erythema and swelling to the area as well. Differential diagnosis Other diagnoses that may present similar to<unk>  that must be excluded prior to making a diagnosis include mechanical low back pain, perineal lacerations, sciatica, urinary tract infections, pelvic and lower extremity vein thrombosis, neoplastic processes, septic arthritis, osteomyelitis,<unk>  osteolysis, and osteitis<unk> . Laboratory tests such as a complete blood cell count looking for elevated white blood cells, inflammatory markers such as lactate, CRP, and ESR, and a urinalysis can help rule out infectious processes that may be causing pelvic pain similar in presentation to<unk> . Imaging This abnormally wide gap can be diagnosed by radiologic studies such as X-ray, Ultrasound, MRI, CT scan or bone scan. While X-Ray is the gold standard to identify a separation of the<unk><unk> , a decision must be made in regard to which imaging modality to utilize that is patient and case-specific. X-ray Separation of the<unk> <unk> <unk>  An X-ray film obtained in the AP view of the pelvic inlet and outlet will show a marked gap between the<unk>  bones. A normal pelvis will show a gap that is 4–5 mm. However in pregnancy the hormonal influences cause relaxation of the connecting ligaments and the bones separate up to 9 mm. A gap measuring greater than 10 mm indicates a pathological process. In addition, a view in the "flamingo stance" can be obtained to demonstrate the instability of the joint. This position consists of the patient standing with weight on one leg and the other bent. A vertical displacement of more than 1 cm is an indicator of<unk> <unk>  instability. A displacement of more than 2 cm usually indicates involvement of the sacroiliac joints. A limitation of this imaging study is that X-rays induce radiation and should be avoided during pregnancy. Ultrasound The utilization of ultrasound to identify pathologic widening of the<unk><unk>  has recently been studied and identified to be a cost-effective way to obtain imaging of the<unk><unk> , especially in the pregnant population, where the radiation should be avoided. CT scan and MRI Both diagnostic machines can produce detailed cross-sections of the pelvic area. Images will show degrees of soft tissue injury, inflammation of the subchondral region and the bone marrow and any abnormal posturing of the pelvic joints. MRI can show a more detailed view of soft tissue injuries that may be associated with<unk> , and is radiation-free, thus making this imaging modality ideal for the pregnant patient.
Pubic Symphysis Diastasis
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Epidural abscess
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Vertebral osteomyelitis
Diastematomyelia
Spinal fracture