All of this stuff in the literature regarding SIJ pain and "Cluster of Laslett" requiring 3 or more pain provocation maneuvers in order to make the diagnosis. This certainly has been adopted by every insurance carrier. I just saw a long time patient , big guy > 300lbs, with at least his third bout of right buttock pain right at the PSIS, worse with transition from sitting to standing and significant TTP at PSIS. I have done every SIJ pain provocation maneuver that I know and none are positive. However, he has done well each and every time with an SIJ injection. I have to say that I almost never can find three maneuvers that are clearly positive and find myself getting creative in interpretation. Am I alone in my experience and is my inferiority complex justified?
SI joint pain without positive pain provocation maneuvers
- Thread starter NJPAIN
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“Everyone lies”…
When it comes to sij, I lie to get it approved. Those provocation maneuvers are BS. Nothing has been as reliable as history and the good ol fortin finger
100%
eff the insurance company and their "guidelines"
don't let clubdeac hear you, though. he has become a boy scout all of a sudden.
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what is your success rate with the SI injections?
if you are stating that you can never get 3 provocative findings, and you get no benefit from SI injection, that would reinforce the correlation, right?
otoh, more likely, you dont get 3 provocative findings but consistently get significant benefit. in that case, either/or 1. the provocative findings are worthless 2. you get benefit from the injection in spite of lack of findings or 3. you may be misinterpreting benefit from the injection when it is actually from the steroid. im guessing it is a combination, probably 1+2.
i wouldnt lie, personally.
repeat exams may reveal findings not obvious initially.
if you are stating that you can never get 3 provocative findings, and you get no benefit from SI injection, that would reinforce the correlation, right?
otoh, more likely, you dont get 3 provocative findings but consistently get significant benefit. in that case, either/or 1. the provocative findings are worthless 2. you get benefit from the injection in spite of lack of findings or 3. you may be misinterpreting benefit from the injection when it is actually from the steroid. im guessing it is a combination, probably 1+2.
i wouldnt lie, personally.
repeat exams may reveal findings not obvious initially.
think 300 lbs of pressure
