Facultad de Medicina Virtual

The purpose of this study it to certify if the presence of PAIN WHEN APPLYING PRESSURE ON THE LESSER TROCHANTER, WITH A STRENGTH LOWER THAN A TROY POUND, IS A TYPICAL SIGN OF ILIOSACRAL DYSFUNCTIONS.

We have tried to objectively observe the co-relationship that exists between the pain when applying pressure on the femoral lesser trochanter and homolateral iliosacral dysfunctions. It is considered that the pain appearing at a pressure lower than the normal tolerance level (a troy pound) on the lesser trochanter in a homolateral iliac dysfunction process is due to the fact that the spasm of the psoas or iliac muscle bundles determines an anomalous traction on the terminal tendon, producing a stimulus on the nociceptors.

An observational transversal descriptive study was performed, which  is developed as an INTEREXAMINER, with eight double-blind examiners.

Forty-four adult patients of both sexes were studied, aged between 20 and 60. They were selected by a systematic randomized method.

Patients gave their consent in writing, and were assessed with no therapeutic intervention being performed.

They are divided into two groups:

Experimental sample with patients presenting pelvic symptomatology and  showing pain on the lesser trochanter in the analogical scale between the marking of 5 and 10: 28 patients

Control sample with patients with no pelvic symptomatology: 16 patients

Although the main purpose is to test the presence of pain at certain pressure levels (lower than 1 troy pound) on the lesser trochanter in order to indicate the existence of iliosacral dysfunctions, the secondary objectives are to analyze the interexaminer reliability as well as to study the relationship between the Gillet Test and the Algometry on the short and long arms of the sacroiliac joint. It is also observed if significant differences exist between the middle levels of the pressure necessary for the presence of pain in the control and experimental group.

The techniques that are used are as follows:

          The logistic regression model is the appropriate technique to test the ratio of low pressure levels to cause pain with the variable, considered as dependent, which is the existence or not of pelvic asymmetry, being the same a dichotomic  variable.

-          The STATISTIX statistical package, by means of which the parameters of logistic regression are estimated.

In order to assess the reliability of the measurements obtained by each interexaminer equipment, the Kappa concordance coefficient is used.

The Student’s T- test is applied to decide if there is a significant difference between the middle pressure levels in both groups (control and experimental).

In the measurement with the algometry, the pain when applying pressure on the lesser trochanter is almost fully coincidental with a homolateral iliosacral dysfunction.

In x-rays, a high incidence of pelvic asymmetries is observed. Therefore, the tolerance limit of 3 mm longitudinal and transversal differences is taken into consideration. In the study on pelvic asymmetries, the dysfunction side cannot be determined, as the observer did not have the assessing data taken by the other professionals.

Not many coincidences of functional alterations such as the postero-external or antero-internal iliac are observed. This result is supposed to be due to the traumatic etiology.

The Gillet test and the algometry on the short and long arms of the sacroiliac joint are coincidental in most of the cases studied.

Therefore, we can assert that the pain when applying low pressures on the lesser trochanter is a clinical sign complementary to the iliosacral dysfunctions