Gaenslen’s Test

Gaenslen’s test can indicate the presence or absence of a sacroiliac joint lesions, pubic symphysis instability, hip joint pathology or L4 nerve root lesion. It can also stress the femoral nerve.

How do you perform the Gaenslen test?

• The patient is positioned supine at the edge of the side of the bed with the painful leg resting very near to the end of the bed, and resting symptoms are assessed.
• The leg furthest from the edge of the bed (non tested leg) is flexed 90 degrees at the hip and held by the clinician using one hand.
• The clinician passively positions the upper leg (test leg) into hyperextension at the hip so that it hangs over the edge of the table.
• The clinician applies a further stretch to the test leg into hip extension and adduction up to six times while a flexion based counter force is applied to the flexed leg.

See Also: Thomas Test

See Also: Three Phase Hyperextension Test or Mennell sign

The Gaenslen test may also be performed with the patient in a lateral position. This is done with the patient lying on his or her normal side with that leg flexed at the hip and knee. The examiner then passively hyperextends the other leg (the one not in contact with the table).

What does a positive Gaenslen Test mean?

If there is dysfunction in the sacroiliac joint, hyperextension of the leg will lead to motion in the sacroiliac joint, causing pain or exacerbation of existing pain and the Gaenslen’s test is considered positive .

Pain may also be caused by hip pathology or an ipsilateral nerve root lesion.

See Also: Lasegue Test

Gaenslen Test Accuracy

This test demonstrates poor diagnostic value secondary to poor to fair specificity. Overall, there is limited research pertaining to this test in order to make strong conclusions.

A study by Parisa Nejati to assess the reliability and validity of motion palpation and pain provocation compared with sacroiliac joint (SIJ) block as the gold-standard assessment method of patients with sacroiliac joint dysfunction (SIJD), he found that the Gaenslen’s test had a sensitivity and a specificity of:

• Sensitivity: 61.5 %
• Specificity: 33.3 %

Another study by Salih Ozgocmen on 40 patients with chronic low back pain, this study aimed to evaluate the value of sacroiliac pain provocation tests in early active sacroiliitis (Mennell test, Gaenslen test and Thigh thrust test), the sensitivity of these tests were 55% for the right side and 45% for the left side. While the specificity were 83% for the right side and 86% for the left side.

This study stated that at least two of three tests need to be positive to indicate sacroiliitis.

Reference

• Hoppenfeld S: Physical Examination of the Hip and Pelvis, Physical Examination of the Spine and Extremities. East Norwalk, CT: AppletonCentury-Crofts, 1976:143.
• McGill SM. Kinetic potential of the lumbar trunk musculature about three orthogonal orthopaedic axes in extreme postures. Spine (Phila Pa 1976). 1991 Jul;16(7):809-15. doi: 10.1097/00007632-199107000-00021. PMID: 1925758.
• Nejati P, Sartaj E, Imani F, Moeineddin R, Nejati L, Safavi M. Accuracy of the Diagnostic Tests of Sacroiliac Joint Dysfunction. J Chiropr Med. 2020 Mar;19(1):28-37. doi: 10.1016/j.jcm.2019.12.002. Epub 2020 Sep 12. PMID: 33192189; PMCID: PMC7646135.
• Ozgocmen S, Bozgeyik Z, Kalcik M, Yildirim A. The value of sacroiliac pain provocation tests in early active sacroiliitis. Clin Rheumatol. 2008 Oct;27(10):1275-82. doi: 10.1007/s10067-008-0907-z. Epub 2008 May 6. PMID: 18458988.
• Clinical Tests for the Musculoskeletal System 3rd Edition.
• Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.