REHAB-03 · Pain Rehabilitation Part 3

Pain Rehabilitation Part 3. Topics: Interventional Procedures and Neuromodulation. Part of the Rehabilitation Topics series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: Clinical guidelines require a cluster of three or more positive provocative tests to suspect SI joint pathology. The mandatory ones to know are the Patrick test, also called the FABER test ... Then there's the Gaenslen test, the supine distraction test, and the thigh thrust test. — Correct: That is the wrong cluster and the wrong threshold. The accuracy-optimised cluster is four tests: distraction, thigh thrust, compression and sacral thrust, with two or more positive giving roughly 88 to 93 percent sensitivity and about 78 percent specificity. It is a stepwise sequence, not a checklist: distraction and thigh thrust first, and if both reproduce the pain you stop there. Gaenslen adds almost nothing to diagnostic power and sits outside the four. The Patrick or FABER test is a hip screening maneuver and was never part of the validated cluster. The six-test framing some sources quote is those four plus Gaenslen performed right and left, where three or more positive gives 94 percent sensitivity. Two further points the audio omits: the joint is ruled out only when no provocation test reproduces the patient's familiar pain, and discogenic pain that centralises must be excluded first, which raises specificity from about 78 to about 87 percent. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/REHAB-03-a.