978 - Pain Getting Into a Truck: A New Symptom of Sacro-iliac Joint Dysfunction

Case Diagnosis: Hip pain

Case Description: A 57-year-old female was referred from orthopedics clinic for chronic, insidious-onset right-sided lower back pain, worsened with getting into a truck or twisting. The pain was sharp, non-radiating, 8/10 in intensity, with no numbness or weakness. She completed PT and chiropractic care in the past with limited temporary relief. She had a childhood history of pes planus and had been using insoles since childhood. The physical examination revealed positive Gaenslen’s maneuver and sacroiliac compression test. The patient was instructed to replicate the action of entering her truck, during which she reported experiencing localized pain around her sacroiliac joint when stepping onto a higher level with her right leg. The remainder of her examination was unremarkable. Subsequently, the patient underwent a therapeutic fluoroscopy-guided injection into the right sacroiliac joint with confirmation via contrast imaging, resulting in complete pain relief. At her 3-month follow up visit, she continued to be pain free.

Discussions:
The sacroiliac joint is a frequently encountered origin of lower back pain, with the reliability of conventional provocative maneuvers displaying considerable variability. Here we introduce a novel sacroiliac joint symptom/sign, anticipated to be more frequently reported in the course of routine daily activities.



Conclusions:

A novel diagnostic indicator—the "truck" symptom/sign—could serve as a valuable tool in discerning and characterizing pathologies associated with the sacroiliac joint. Further formal study of this symptom/sign may be warranted.