Perhaps the biggest reason for misdiagnosis or lack of diagnosis of<unk>  is based on the inability of common radiological imaging to discern the disorder. Diagnostic testing, such as X-ray, CT scan, or MRI, do not usually reveal abnormalities; therefore, they cannot reliably be used for diagnosis of<unk> . There is a new imaging test SPECT/CT which can sometimes detect<unk> . There is also a lack of evidence that<unk><unk>  mobility maneuvers (Gillet, Standing flexion test, and Seated Flexion test) detect motion abnormalities. Given the inherent technical limitations of the visible and palpable signs from these<unk><unk>  mobility maneuvers another broad category of clinical signs have been described called provocative maneuvers. These maneuvers are designed to reproduce or increase pain emanating within the<unk><unk> . A clinician (i.e., a spine surgeon, orthopedic surgeon, sports medicine doctor, athletic trainer, medical massage therapist, physical therapist, physiatrist, osteopath or chiropractor) can develop a probable diagnosis of<unk>  by using a hands on approach through palpating the painful areas and performing the following provocative maneuvers below: * Gaenslen test - This pain provocation test applies torsion to the<unk> . With one hip flexed onto the abdomen, the other leg is allowed to dangle off the edge of the table. Pressure should then be directed downward on the leg in order to achieve hip extension and stress the<unk><unk> . * Iliac Gapping Test - Distraction can be performed to the anterior<unk>  ligaments by applying pressure to the anterior superior iliac spine. * Iliac Compression Test - Apply compression to the<unk>  with the patient lying on his or her side. Pressure is applied downward to the uppermost iliac crest. * FABER or Patrick test - To identify if pain may come from the<unk><unk>  during flexion, abduction, and external rotation, the clinician externally rotates the hip while the patient lies supine. Then, downward pressure is applied to the medial knee stressing both the hip and<unk><unk> . * Thigh Thrust - This test applies anteroposterior shear stress on the SI<unk> . The patient lies supine with one hip flexed to 90 degrees. The examiner stands on the same side as the flexed leg. The examiner provides either a quick thrust or steadily increasing pressure through the line of the femur. The pelvis is stabilized at the sacrum or at the opposite ASIS with the hand of the examiner Cautious interpretation is warranted because there are no biomechanical studies showing that the Thigh Thrust test isolates forces in the SIJ when performed at 90 degrees and due to intra-individual variation in body type, hip flexibility, general flexibility of the trunk and pelvis. In all the tests, pain along the typical area raises suspicion for<unk> . However no single test is very reliable in the diagnosis of<unk> . It is important to remember true neurogenic weakness, numbness, or loss of reflex should alert the clinician to consider nerve root pathology. The current "gold standard" for diagnosis of<unk>  emanating within the<unk>  is<unk><unk>  injection confirmed under fluoroscopy or CT-guidance using a local anesthetic solution. The diagnosis is confirmed when the patient reports a significant change in relief from pain and the diagnostic injection is performed on 2 separate visits. Published studies have used at least a 75 percent change in relief of pain before a response is considered positive and the<unk><unk>  deemed the source of pain. However, several other injection studies have compared intra-articular with extra-articular injection, and indicate that the ligament injection behind the<unk>  is oftentimes superior to injection in the<unk>  and seems to be a very underutilized diagnostic tool. Misdiagnosis In the early 1900s,<unk>  of the<unk><unk>  was a common diagnosis associated with low back and sciatic nerve pain. However, research by Danforth and Wilson in 1925 concluded that the<unk><unk>  could not cause sciatic nerve pain because the<unk>  does not have a canal in which the nerves can be entrapped against the<unk> . The biomechanical relationship between the<unk><unk> , the piriformis muscle (see “piriformis syndrome”), and the sciatic nerve had not yet been discovered. In 1934, the work of Mixter and Barr shifted all emphasis in research and treatment from the<unk>  to the herniated intervertebral disc, namely lumbar discs. Medical focus on herniated discs was further forwarded by the invention of the MRI in 1977. Over-diagnosis and attention on herniated discs has led to the SI<unk>  becoming an underappreciated pain generator in an estimated 15% to 25% of patients with axial low back pain. The ligaments in the<unk>  are among the strongest in the body and are not suspected by many clinicians to be susceptible to spraining or tearing. Skepticism of the existence of<unk>  within the medical community is furthered by the debate on how little or much the<unk><unk>  moves. A discrepancy as large as 2-17 degrees has been reported in clinical findings.
Sacroiliac joint dysfunction
Radicular pain
Pelvic girdle pain
Jaw claudication
Back pain
Tendinopathy
Low back pain
Xiphodynia