STATTON, Brett CHIR13008 Assessment one Due Date 22/5/19

Reflection on assignment and clustering:

Orthopaedic tests in general are designed to place stress on isolated structures that the
practitioner deems necessary to evaluate in regard to a patient’s pain or dysfunction.
These tests help to determine the tissue in lesion, and either rule in or out a differential
diagnosis.
The assignment gave us the opportunity to investigate how clustering can work to the
practitioner’s advantage. In reality this would seem to be common sense, however the
studies behind why and what tests are involved in clustering are thought-provoking. Why is
one test considered to be superior to another?
To help the chiropractor determine the clinical legitimacy of each test the sensitivity and
specificity values must be noted and taken into consideration. Sensitivity is the proportion
of those with the disorder that test positive to the test and specificity is the proportion of
those without the disorder who test negative.

A systematic review of spinal orthopaedic tests by Simpson and Gemmell (2006) concluded
that in general many orthopaedic tests had poor sensitivity and specificity. However, by
clustering or grouping three or more similar tests together they were deemed more reliable
(Muscolino, 2010).

Additionally, in 2005 Laslett studied the validity of orthopaedic tests and ultimately
determined that clustering certain tests together gave a more reliable clinical diagnosis of SI
dysfunction. Laslett’s (2005) studies showed that the distraction test, thigh thrust,
compression and sacral thrust tests when clustered together improved the diagnostic ability
of determining SI pathology. Thigh thrust and distraction tests have the highest individual
sensitivity and specificity (Laslett et al., 2005). The study also showed that if any two tests
showed as positive then the test can be stopped and a diagnosis of SI dysfunction can be
made (Laslett et al., 2005). It is also noted that the Gaenslens test did not contribute to a
better diagnosis and may be omitted from the diagnostic process altogether (Laslett et al.,
2005). I found this perplexing as the Gaenslens test put the pelvis into maximum torsion, so
was it not included? Perhaps as it can be a more provocative test there was no need for it to
be included if the others tested positive.

Similarly, Wurff (van der Wurff, Buijs, & Groen, 2006) studied five sacroiliac joint
orthopaedic tests these included distraction, compression, thigh thrust, Gaenslen and Patrick
Fabre tests. The study concluded that when at least three of these tests are positive the
possibility of SI lesion is between 65% and 93% (van der Wurff et al., 2006). Surprisingly the
Gaenslen test was included in this cluster.

On the whole, its evident how clustering improves the identification of an SI lesion. This is
important in the clinical setting when diagnosing tissue end lesion. As the practitioner is there
to serve the client and to be able to do that the practitioner needs to understand the limitations
of single orthopaedic tests.

References
STATTON, Brett CHIR13008 Assessment one Due Date 22/5/19

Laslett, M., Aprill, C. N., McDonald, B., & Young, S. B. (2005). Diagnosis of Sacroiliac Joint
Pain: Validity of individual provocation tests and composites of tests. Manual
Therapy, 10(3), 207-218. doi:10.1016/j.math.2005.01.003
Muscolino, J. (2010). Orthopedic assessment of the sacroiliac joint.(body mechanics).
Massage Therapy Journal, 49(3), 91.
Simpson, R., & Gemmell, H. (2006). Accuracy of spinal orthopaedic tests: a systematic
review. Chiropractic & osteopathy, 14, 26-26.
van der Wurff, P., Buijs, E. J., & Groen, G. J. (2006). A multitest regimen of pain provocation
tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures.
Arch Phys Med Rehabil, 87(1), 10-14. doi:10.1016/j.apmr.2005.09.023