What is the optimal rule to perform the orthopedic test in Laslett's criteria?

• A. Perform and stop when there are 2 positives (without Gaenslen's)
• B. Test in order and count all positives including Gaenslen's
• C. Stop after the first positive test
• D. Count positives across all tests

Answer: (A)

Laslett's criteria use a cluster of provocative maneuvers to identify sacroiliac joint dysfunction, with the idea that multiple positive tests from different stress patterns increase the likelihood that the SI joint is the pain source. The practical rule is to perform the four main provocative maneuvers (compression, distraction, thigh thrust, and Patrick’s/FABER) and stop as soon as you obtain two positive results. This threshold provides a good balance between sensitivity and specificity and keeps the examination efficient.

Gaenslen's test is often considered separately or added as a fifth test in some protocols; if you include it, the same two-positives rule among all five isn't as commonly used, which is why the streamlined approach uses two positives among the four tests without Gaenslen's. Using that early-stopping rule avoids unnecessary testing while still maintaining diagnostic confidence in SIJ involvement.