Do you know the seven "unconventional" examination methods for ankylosing spondylitis?

Ankylosing spondylitis (AS) is a relatively difficult disease to treat clinically and is a global treatment problem. Therefore, in addition to conventional treatment, AS patients must also pay attention to daily exercise to relieve symptoms. So what are the non-routine examinations for this disease?

1. Single hip extension test

Also known as the leg-lifting test and Yangmen test. The patient lies prone with both lower limbs straight and together. The examiner holds the ankle of the affected side or supports the knee with one hand to excessively extend the hip joint, and presses the sacrum with the other hand. At this time, the quadriceps femoris is tense, and the ilium tilts forward and rotates. If pain occurs in the sacroiliac joint on that side, it is positive, indicating a sacroiliac joint disease.

2. Single-leg hop test

Do the healthy side first. If there is no damage to the waist, there should be no pain when jumping on one leg with weight on the healthy side. Then perform the affected side. If the sacroiliac joint is painful or the patient cannot jump when doing the weight-bearing jumping test on the affected side with one leg, it is a positive result. After excluding the influence of lesions of the hip joint, knee joint, spine, etc., most of the lesions are sacroiliac joints.

3. Pelvic rotation test

The patient sits and the examiner faces the patient. He holds the patient's knees with his legs to fix the pelvis. He then supports the patient's shoulders with both hands to rotate the trunk left and right. If there is a disease in the sacroiliac joint on either side, pain will occur, which is a positive test.

4. Sacroiliac joint positioning test

The patient lies on his back, and the examiner holds the patient's lower knees with his right hand, flexing the hip joint to a right angle. The calf naturally rests on the examiner's right arm. The examiner presses the knees with his left hand to keep the pelvis close to the examination table. Ask the patient to relax his muscles and use his thighs as levers to squeeze the pelvis to the right and left. If the pain is mild when squeezed but obvious when pulled apart, it indicates joint changes in the sacroiliac joint.

5. Sacroiliac joint compression test

The sacroiliac joint is generally not palpable due to the prominent ilium and the presence of ligaments that support the joint. However, the line connecting the posterior superior iliac spines on both sides is equivalent to the level of the second sacrum and passes through the center of the sacroiliac joint, which can be used as a reference for positioning. Press the sacroiliac joint directly. If local pain occurs, it indicates that the joint is affected.

6. Sacroiliac joint push test

The patient lies in the supine position, and the examiner places both hands on the patient's iliac crest, with the thumbs placed on the anterior superior iliac spine, the palms pressing the iliac tuberosities, and pushing the pelvis hard. If there is pain around the sacroiliac joint, this indicates that the joint may be diseased.

7. Hanging leg push test

The patient lies in supine position with legs suspended in the air, one leg flexed at the hip and knee, and the other leg straight at the hip and knee. The examiner uses one hand to hold the lower part of the knee of the raised leg and pushes it toward the shoulder; with the other hand, he presses down on the upper part of the knee joint of the other leg. If the sacroiliac joint is diseased, pain will occur.