Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review
Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review
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DOI：
10.1016/j.ajog.2018.06.014
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发表时间：
2018-11-01
影响因子：
9.8
通讯作者：
Lowder, Jerry L.
中科院分区：
文献类型：
--
作者：
Meister, Melanie R.;Shivakumar, Nishkala;Lowder, Jerry L.
背景技术背景：肌筋膜疼痛的特征在于存在触发点、触诊压痛和局部或牵涉性疼痛，并且通常涉及男性和女性的骨盆底肌肉。在有下尿路症状的患者中也观察到了没有局部或牵涉性疼痛的盆底肌筋膜疼痛，我们发现许多患者报告在接受针对肌筋膜的盆底物理治疗后这些症状得到了改善。目的：我们试图系统地回顾文献中用于评估女性盆底肌筋膜疼痛的检查技术。我们使用奥维德MEDLINE 1946-、Embase 1947-、Scopus 1960-、科克伦对照试验中心登记系统、疗效评价摘要数据库和科克伦系统评价数据库中有关盆底疾病、肌筋膜疼痛和诊断概念的策略进行了系统性文献检索。文章由3位作者筛选，如果包含骨盆肌筋膜体格检查的描述，则纳入。总体而言，纳入的研究中检查成分差异显著，并且通常不明确。根据现有数据制定了共识检查指南，包括使用个位数（62%，34/55）进行阴道触诊肛提肌占75%（41/55）（87%，48/55）和闭孔内肌（45%，25/55）肌肉，患者报告量表评估触诊疼痛水平结论：评估骨盆肌肉系统是否存在肌筋膜疼痛的体格检查方法差异很大，并且通常不明确。鉴于盆底肌筋膜疼痛在慢性盆腔疼痛中的已知作用以及盆底肌筋膜疼痛与下尿路症状之间的联系，医生应接受培训，以评估盆底肌筋膜疼痛，作为出现这些症状的患者体检的一部分。因此，需要开发和标准化可靠和可重复的检查。
BACKGROUND: Myofascial pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor myofascial pain in the absence of local or referred pain has also been observed in patients with lower urinary tract symptoms, and we have found that many patients report an improvement in these symptoms after receiving myofascial-targeted pelvic floor physical therapy.OBJECTIVE: We sought to systematically review the literature for examination techniques used to assess pelvic floor myofascial pain in women.STUDY DESIGN: We performed a systematic literature search using strategies for 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 3 authors and included if they contained a description of a pelvic myofascial physical examination.RESULTS: In all, 55 studies met our inclusion criteria. Overall, examination components varied significantly among the included studies and were frequently undefined. A consensus examination guideline was developed based on the available data and includes use of a single digit (62%, 34/55) to performtransvaginal palpation (75%, 41/55) of the levator ani (87%, 48/55) and obturator internus (45%, 25/55) muscles with a patient-reported scale to assess the level of pain to palpation (51%, 28/55).CONCLUSION: Physical examination methods to evaluate pelvic musculature for presence of myofascial pain varied significantly and were often undefined. Given the known role of pelvic floor myofascial pain in chronic pelvic pain and link between pelvic floor myofascial pain and lower urinary tract symptoms, physicians should be trained to evaluate for pelvic floor myofascial pain as part of their physical examination in patients presenting with these symptoms. Therefore, the development and standardization of a reliable and reproducible examination is needed.