[Symptomatic approach to musculoskeletal dysfunction and chronic pelvic and perineal pain].
BACKGROUND
Clinical examination of a patient with chronic pelvic and perineal pain often demonstrates muscle hypertonia or muscle contracture sometimes associated with local tenderness or real muscle trigger points. It is sometimes very difficult to determine whether this muscle pain detected on clinical examination is the cause or a consequence of the pain. The purpose of this article is to review musculoskeletal dysfunction in the context of chronic pelvic and perineal pain.


METHODS
Review of the literature devoted to musculoskeletal aspects of pelvic and perineal pain.


RESULTS
Definitions of pelvic floor dysfunction, hyperactive pelvic floor, myofascial pain and muscle trigger points, and the concept of fibromyalgia.


CONCLUSIONS
Musculoskeletal pain is certainly underestimated in the management of chronic pelvic and perineal pain. The pathophysiology of musculoskeletal pain involves disorders of the lumbar, pelvic and femoral equilibrium, myofascial pain characterized by the presence of trigger points for which the pathophysiology remains controversial: a purely muscle disease, reaction to adjacent inflammatory reactions causing hypersensitization, or simply a sign of central hypersensitization in a context of chronic pain syndrome.
Centre fédératif de pelvipérinéologie, clinique urologique, CHU de Nantes, 44093 Nantes, France. jjlabat@chu-nantes.fr
J-J
JJ
Labat
M
M
Guerineau
D
D
Delavierre
L
L
Sibert
J
J
Rigaud
D002908:Chronic Disease; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D009209:Myofascial Pain Syndromes / Q000175:diagnosis; D017699:Pelvic Pain / Q000175:diagnosis* / Q000503:physiopathology; D010502:Perineum