86: Evidence-based physical examination techniques for the diagnosis of pelvic floor myofascial pain: A systematic review

Abstract

Levator ani (LA) and obturator internus (OI) myofascial pain is common in patients presenting with chronic pelvic pain. These patients often have co-existing pelvic floor symptoms, but there is limited data on the best method(s) to diagnose myofascial pain in these patients. The objective of our study is to systematically review the literature for examination techniques used to identify LA and OI myofascial pain in patients with pelvic floor symptoms and chronic pelvic pain. A comprehensive literature search was performed using strategies to identify the concepts of pelvic floor disorders, myofascial pain, and diagnosis in Ovid Medline 1946-, Embase 1947-, Scopus 1960-, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Database of Systematic Reviews. Articles were screened by three authors and included if they contained a description of a pelvic myofascial physical examination. Data was extracted and analyzed utilizing a data sheet developed a priori. Fifty-three studies met our inclusion criteria: 2 randomized controlled trials, 6 prospective cohort studies, 8 retrospective cohort and case-control studies, 19 cross sectional studies and 18 general review or expert opinion articles. The majority of studies used a single digit (64%, 34/53) to perform transvaginal palpation (77%, 41/53) of the levator ani (89%, 47/53) and obturator internus (42%, 25/53) muscles and used a patient-reported scale to assess tenderness (53%, 28/53; Table). Physical examination methods for evaluating pelvic musculature for presence of myofascial pain varied significantly and were often undefined. While some agreement exists on which muscles to assess and use of (0-10) pain scales, there is little consensus on methods to identify muscles or muscle palpation techniques. Future work to standardize a reliable and reproducible examination is needed.