Watch the video version of this episode on YouTube - https://youtu.be/-FmTa6-78KA

A patient is referred to physical therapy with a diagnosis of lumbar degenerative disk disease. The physical therapist theorizes that the sacroiliac joint may be the true source of the patient’s symptoms. Which test should be included in the examination when trying to confirm a diagnosis of sacroiliac joint dysfunction?

1. Slump test
2. Standing flexion test
3. Leg length test
4. Thigh thrust test

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient is referred to physical therapy with a diagnosis of lumbar degenerative disk disease. The physical therapist theorizes that the sacroiliac joint may be the true source of the patient’s symptoms. Which test should be included in the examination when trying to confirm a diagnosis of sacroiliac joint dysfunction?

1. Slump test
2. Standing flexion test
3. Leg length test
4. Thigh thrust test

Sacroiliac Joint Dysfunction
Sacroiliac (SI) joint dysfunction can be one of several possible causes for low back pain. A clinical prediction rule utilizing a cluster of six tests is often used to determine the likelihood that a patient’s pain is originating from the SI joint. If three or more tests are positive, then the patient’s pain is likely arising from the SI joint.

Let’s explore each of the options:

Option 1 - Slump test
Slump Test
The slump test is performed with the patient positioned in sitting. The patient is asked to move into lumbar and thoracic flexion and then bring their chin toward their chest. The therapist then extends the patient’s knee and places the ankle in dorsiflexion. If the patient’s symptoms are recreated in this position, the therapist has the patient extend their neck. 

If symptoms decrease with neck extension, the test is positive for neural tension. This test is typically used to identify nerve root tension at the lumbar spine (e.g., from a disk herniation) and would not be useful in diagnosing SI joint dysfunction.

Option 2 - Standing flexion test
Standing Flexion Test
The standing flexion test is performed by having the patient bend forward to touch their toes as the therapist palpates each posterior superior iliac spine. Theoretically, an asymmetry in movement between the two sides would suggest an issue with the SI joint. However, tests that rely on palpation of the SI joint typically have poor reliability and thus have limited use when trying to diagnose a patient with SI joint dysfunction.

Option 3 - Leg length test
Leg Length Test
Measuring leg length is typically performed with the patient in supine. The therapist measures from the anterior superior iliac spine to the medial (or lateral) malleolus and compares the measurements. While leg length discrepancy is sometimes assessed for patients with SI joint dysfunction, a strong correlation between the two has not been identified.

Option 4 - Thigh thrust test
Thigh Thrust Test
The thigh thrust test is performed with the patient in supine. The therapist passively flexes the hip to 90 degrees with the knee flexed. The therapist then places one hand under the sacrum while applying a downward force through the femur with the other hand. If the patient experiences pain over the SI joint, the test is positive for SI joint dysfunction. The thigh thrust test is part of the test cluster that can be used to diagnose SI joint dysfunction. The other tests include the sacroiliac compression test, sacroiliac distraction test, sacral thrust test, and Gaenslen’s test (performed bilaterally). Since the Gaenslen’s test is performed bilaterally this counts as two separate tests and results in a cluster of six, not five, tests.

The correct answer is Option 4

This question was fairly challenging, but for most candidates it should have been possible to readily eliminate two of the options - Option 1 - Slump test and Option 3 - Leg length test.

Remember even if you are not sure of the correct answer for a given question, it’s critical to use your existing academic knowledge and clinical decision making skills to improve the probability of selecting the correct option.

In addition, take the time when reviewing questions to remediate any information within the explanations that is foreign to you.

For example, it’s possible that one or more of the special tests listed in the test cluster in option 4 may be unfamiliar. Leave no stone unturned in your quest to be licensed!

Let’s explore the all student data:
5% of students selected Option 1, Slump test
25% of students selected Option 2, Standing flexion test
10% of students selected Option 3, Leg length test
60% of students selected Option 4, Thigh thrust test- the correct response

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content? Check out pages 115-116 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!