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Sacroiliac Joint Special Test: Thigh Thrust Test
The Thigh Thrust Test is a diagnostic test used to assess the mobility of the sacroiliac joint. During the test, the patient lies face down and the examiner applies a downward pressure to the back of the patient’s thighs. This pressure causes a posterior rotation of the pelvis, which can help to identify any areas of tenderness and/or restriction that occur around the sacroiliac joint. The Thigh Thrust Test can help to diagnose or rule out sacro
Transcript
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This is Brent of the Brookbush Institute
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in this video we're going over another
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special or orthopedic tests for sacroiliac joint pain, this is the thigh
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thrust test. I'm going to have my friend Melissa come out she's going help me
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demonstrate. Now I think you guys will find that the trickiest part of this
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test is setup, and it all comes down to trying to get this hand on the sacral
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base. Now notice that Melissa is in supine and it should be that wherever
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she's having symptoms, the sacroiliac joint that we think is involved is
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further from us, and what we're going to do in this test is I'm going to brace her
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sacrum with this hand, and then using her thigh I'm going to create a posterior force
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that's going to take her pelvis and shear that joint. Alright so we're going to
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shear the innominate on a stabilized sacrum. So now the question is how do I
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get this underneath your sacrum, and this is where all sorts of awkwardness
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happens if you don't do a little practicing before you see a patient
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using this test. I'm going to lift this leg up, I'm going to then pull Melissa over
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towards me, this way I can put my hand into position this way and roll her back
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over my hand. Don't try to slide your hand underneath their
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backside that is that is not going to gain you any rapport with a new patient or
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client that you're doing an assessment on. Now I will say it is a little tricky
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to get this hand in the right spot, because remember we have to stabilize
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the sacrum but not the innominate. If you put this like let's say that the sacrum
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ends up on this side of my hand and like her PSIS over her innominate is on this side
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of the hand and I push down, nothing's going to happen.
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I'm just going to push both of those things right down into my hand, rather than me
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having the sacrum in this hand with the innominate coming off the edge. All right so what
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you're going to end up having to do is try to kind of find her ilium and then
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maybe her PSIS as we've been using that bottom corner of the PSIS as a
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landmark and then try to get medial to that PSIS. Now it's okay for your hand to
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end up all the way on this innominate, that's
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fine. I can stabilize her, in this case left and innominate and sacrum and then
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push her right innominate over the edge, what I can't do is have sacrum and right
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innominate stabilized. So for those of you guys with bigger hands what you
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might want to do is kind of find even if you had to the middle of the sacrum and
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then roll them back, and I just missed a little bit, let me get a little further
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over. Alright now I can feel I have her sacrum stabilized, but all
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this side is hanging off the side of my hand. Now I'm going to use this arm,
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notice that my elbow is in line with the direction that I want to push, and I'm
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going to do a little thrust, right did that provoke your symptoms? No that didn't
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provoke her symptoms. Alright and I might give it a couple, how about that? Almost,
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you feel like there might be something there. Alright and if you guys can, if
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you happen to be tall enough, different enough in size you could try getting
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more of a thrust with your torso. How was that? Okay, alright so she's probably not
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positive she's only getting a hint of uncomfortableness, which it's a
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special test meant to provoke symptoms it's probably not going to be that
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comfortable. So let me review that set up one more time. She's supine, the side that
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we think is involved is furthest away from me. I want to get this hand on her
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sacrum, I want this in innominate hanging off my hand. So the way I'm going to do that
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is pull this leg up like this, tilt her really far over towards me. Notice
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I'm bracing my thigh right against the table so she can't fall off the table.
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I'm then going to bring this hand down, it's okay that I stabilize the opposite
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innominate as long as I get this part of my hand over her sacrum, and this pelvis is
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hanging off. Alright so I found her PSIS, I went off medially, now as I roll her
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back I've just got to make sure that
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my hand doesn't slide over with it. Now I can feel that her sacrum is stabilized and
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this side moves. Once I'm there I'm then going to make sure that my elbows in
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line with the force I'm trying to create, and I'm actually using my chest here to
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kind of stabilize her thighs so it doesn't move around on me
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and I give her a good little thrust. How did that feel? That didn't
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provoke any of the complaints you were talking about when you walked in?
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Remember we're not just looking for pain, uncomfortableness, soreness, we're
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looking for the concordant sign, the complaints that she walked into the
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office with. So there you go, this isn't a great test as most SI joint
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tests are not great tests, they tend to be pretty specific, if they are positive
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they probably are sacroiliac joint dysfunction. But all of these tests
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have a hard time with sensitivity, this is one of those tests that is going to
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be used in our clusters though so keep this test in your repertoire, get some
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practice in with that hand positioning. It's as you can imagine it could get a
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little awkward and maybe a little inappropriate kind of fast,
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absolutely accidentally, grab a couple of your colleagues who know of the tests
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and and get some practice in before you try this with a patient. I look
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forward to hearing about any questions you have in the comments box below. I'll
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