Fortin Finger Test

What is sacroiliac joint dysfunction?

Sacroiliac joint dysfunction is a condition that affects the sacroiliac (SI) joint, which connects the sacrum (the triangular bone at the bottom of the spine) to the pelvis. This joint can become a source of pain due to various factors, including injury, inflammation, or degeneration. Sacroiliac joint abnormalities can also contribute to pain in this area. Several factors can lead to SI joint dysfunction:

• Trauma or injury to the SI joint
• Arthritis or degeneration of the SI joint
• Pregnancy and childbirth, which can cause changes in the pelvis
• Inflammation due to conditions like ankylosing spondylitis
• Abnormal gait or movement patterns that stress the SI joint

If your patient manifests the following symptoms, they may have sacroiliac joint syndrome:

• Chronic low back pain that radiates to the buttocks
• Pain around the posterior superior iliac spine
• Pain that radiates to the upper thigh or groin
• Stiffness and reduced range of motion in the lower back
• Increased pain when standing up from a sitting position or prolonged standing
• Discomfort when climbing stairs or running

Detecting and diagnosing SI joint dysfunction involves a combination of clinical evaluation and diagnostic tests. It involves taking the patient's medical history and a physical examination that identifies tenderness over the SI joint and assesses the range of motion. Then, you can screen using the Fortin Finger Test before moving forward with other provocative tests such as the Flexion, Abduction, and External Rotation (FABER) Test and Gaenslen's Test. These may be done to exclude other potential pain sources, such as posterior joint pain sources and zygapophyseal joint pain generators. The last step before a confirmation is doing imaging studies like X-rays, MRI, or CT scans, which can rule out other causes of lower back pain and provide detailed images of the SI joint.

In some cases, SI joint injections can be done for diagnosis. These involve injecting a local anesthetic into the painful region; if the patient's lower back pain is temporarily relieved, it confirms the diagnosis. Provocation-positive joint injections are also used to validate positive findings of sacroiliac joint abnormalities.

What is the Fortin Finger Test?

The Fortin Test is a clinical assessment to detect sacroiliac joint dysfunction. It helps identify SI joint pain, often associated with lower back and lower limb pain. During the test, the patient is asked to use one finger to localize the area of pain. The examiner notes the location and allows the patient to relax. After five to ten minutes, the examiner asks the patient to identify the spot where they feel the most pain once more.

A positive test is indicated when the patient identifies the painful region as the area inferomedial to the posterior superior iliac spine (PSIS) within 1 cm on two separate occasions. This consistent localization of pain suggests sacroiliac joint dysfunction (Fortin & Falco, 1997).

How to use our Fortin Finger Test template?

The Fortin Finger Test template is designed to help you accurately assess sacroiliac joint dysfunction in patients. It also contains an image to specifically point out where the pain should be radiating. Follow these steps to utilize the template effectively:

Step 1: Download and prepare the template

Begin by clicking "Use template" to open the Fortin Finger Test template on the Carepatron app's template viewer. From there, you can customize it, fill it out digitally, or print it out. You can also download a non-customizable but digitally fillable PDF by clicking "Download." You may also print out a copy for each patient you plan to assess. Familiarize yourself with the template's structure and sections to ensure a smooth testing process.

Step 2: Record patient information

Fill out the patient information section, including the patient's name, date of birth, gender, test date, height, and weight. Accurate patient details are crucial for effectively tracking differential diagnoses and managing their condition.

Step 3: Explain the purpose and procedure

Clearly explain the purpose of the Fortin Finger Test to the patient. Inform them that the test helps detect sacroiliac joint dysfunction and guide them through the steps they will need to follow during the test. This preparation helps gain their cooperation and ensure accurate results.

Step 4: Conduct the test and record the findings

Use the instructions included in the template to conduct the test. Record their responses and any observations in the results section of the template afterward.

Step 5: Interpret the results and plan the next steps

Interpret the results based on the patient's consistency and sensitivity in identifying the painful area. Use the indicators provided in the template to determine if the sacroiliac joint is the likely source of pain. Document your findings and discuss the next steps with the patient, including further diagnostic tests or a treatment plan with sacroiliac joint interventions.

Benefits of using our template

If you are a physical therapist, pain physician, or chiropractor, you can benefit from using our Fortin Finger Test template in many ways:

Standardized documentation

Our template consistently captures all necessary information, promoting accuracy and completeness in patient records. This standardization helps maintain high-quality documentation that can be quickly reviewed and referenced.

Time efficiency

Healthcare professionals can quickly and efficiently conduct and record the Fortin Finger Test for patients following a structured format. This efficiency allows more time to focus on patient care and other critical tasks.

Improved diagnostic accuracy

The template guides professionals through each step of differential diagnosis, ensuring no critical element is overlooked. This thoroughness improves the likelihood of accurately diagnosing sacroiliac joint dysfunction, leading to better patient outcomes.

Reference

Fortin, J. D., & Falco, F. J. (1997). The Fortin finger test: An indicator of sacroiliac pain. American Journal of Orthopedics (Belle Mead, N.J.), 26(7), 477–480. https://pubmed.ncbi.nlm.nih.gov/9247654/