Purpose/Hypothesis: The purpose of this study is to determine if women with chronic pelvic pain (CPP) demonstrate a greater number of abnormal musculoskeletal findings when compared with women without CPP. Specifically, we asked:

On what items do women with pelvic pain present with more significant physical exam findings?

Do women with pelvic pain present a different clinical picture than women with no pain?

Are women with a higher number of positive musculoskeletal exam findings more likely to report pelvic pain?

Number of Subjects: 48 female patients: 19 with chronic pelvic pain, history of at least 3 months (not solely menstrual pain) 29 with no history of back or pelvic pain. Materials/Methods: One physiatrist and one physical therapist performed 9 musculoskeletal physical exam maneuvers on each study participant. There was a total of 4 examiners, 2 physiatrists and 2 physical therapists. The examiners were blinded as whether the subjects had pain or no pain. Relative frequency of positive findings between groups was assessed using chi-squared test of proportion. The total number of positive physical exam findings were tallied to create a Total Musculoskeletal Dysfunction Score. Sensitivity and specificity analyses were conducted. Results: Chi square test of proportion shows that women with pelvic pain were more likely to have abnormal musculoskeletal exam findings identified by physical therapists on 4 of the 9 maneuvers. Women with CPP also presented with more abnormal findings than subjects with no pain. Sensitivity and specificity analyses indicated using two tests, forced FABER and pelvic floor muscle palpation, physical therapists accurately classified women with CPP 85% of the time. Conclusions: Physical exam maneuvers performed by physical therapists can be used to identify patients with musculoskeletal issues related to CPP. Women with CPP present with more signs of musculoskeletal dysfunction when compared to women without CPP. Women with a higher number of positive exam findings by a PT were more likely to have CPP. Clinical Relevance: Musculoskeletal factors significantly contribute to female chronic pelvic pain. A musculoskeletal basis to CPP can be identified by physical therapists using physical exam maneuvers to make earlier and more precise diagnosis of musculoskeletal pelvic pain.