Lillemon Jennifer Nicole, Nardos Rahel, Kaul Matthew P, Johnson Angela N, Choate Amy, Clark Amanda L
Department of Physical Medicine and Rehabilitation.
Department of Physical Therapy, and.
Female Pelvic Med Reconstr Surg. 2019 Mar/Apr;25(2):e34-e39. doi: 10.1097/SPV.0000000000000662.
The internal pelvic floor muscles that support the pelvic viscera lie within the external pelvic structures, which support posture and locomotion. The presence of pain in the hip, groin, leg, abdomen, and/or back in patients with pelvic pain suggests that external pelvic sites may act as pain generators that contribute to chronic pelvic pain (CPP). The aim of this study was to report musculoskeletal diagnoses resulting from including a physiatry evaluation as part of a Multidisciplinary Pelvic Pain Clinic for women with complex chronic pain.
This retrospective case series was conducted by chart review of all women attending the clinic from February 2016 through March 2018. Variable definitions were created for each demographic and clinical characteristic and used to guide a structured review of the chart. Descriptive statistical analysis was performed.
Ninety-six percent of the 68 women (mean age, 51 years) had CPP of 6 months' duration or longer. Levator ani tenderness was present in 81% and obturator internus tenderness in 81%. Seventy-one percent of women had failed pelvic physical therapy. Musculoskeletal diagnoses included osteoarthritis, tendinopathies, enthesopathies, osteitis pubis, ischiofemoral impingement, Paget disease, and other systemic conditions.
Musculoskeletal abnormalities were common in this highly selected cohort of complex CPP cases with external pelvic symptoms. The imaging findings and specific diagnoses allowed targeted therapy beyond generalized physical therapy for CPP. The expertise of urogynecologists and physical therapists who evaluate the internal pelvic muscles and viscera combined with the physiatrist's expertise in musculoskeletal assessment and imaging provides an expanded, collaborative approach for managing these patients.
支撑盆腔脏器的盆底内部肌肉位于支撑姿势和运动的盆腔外部结构内。盆腔疼痛患者出现髋部、腹股沟、腿部、腹部和/或背部疼痛，提示盆腔外部部位可能是导致慢性盆腔疼痛（CPP）的疼痛源。本研究的目的是报告在多学科盆腔疼痛诊所中，将物理医学评估纳入对患有复杂慢性疼痛的女性患者的诊疗过程后所做出的肌肉骨骼诊断。
本回顾性病例系列研究通过查阅2016年2月至2018年3月期间在该诊所就诊的所有女性患者的病历进行。针对每个人口统计学和临床特征制定了可变定义，并用于指导对病历的结构化审查。进行了描述性统计分析。
68名女性患者（平均年龄51岁）中，96%患有持续6个月或更长时间的CPP。81%的患者存在肛提肌压痛，81%存在闭孔内肌压痛。71%的女性盆腔物理治疗效果不佳。肌肉骨骼诊断包括骨关节炎、肌腱病、附着点病、耻骨炎、坐骨股骨撞击症、佩吉特病和其他全身性疾病。
在这一经过高度筛选的伴有盆腔外部症状的复杂CPP病例队列中，肌肉骨骼异常很常见。影像学检查结果和具体诊断使得针对CPP的治疗能够超越一般的物理治疗。评估盆腔内部肌肉和脏器的泌尿妇科医生及物理治疗师的专业知识，与物理医学专家在肌肉骨骼评估和影像学方面的专业知识相结合，为管理这些患者提供了一种扩展的、协作性的方法。
