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Differential Diagnosis of Endometriosis in a Young Adult Woman With Nonspecific Low Back Pain

MR Troyer, PT, DPT, is a staff physical therapist working in outpatient musculoskeletal rehabilitation in Philadelphia, Pa

Address all correspondence to Dr Troyer at: mtroyer1{at}msn.com

Background and Purpose: Endometriosis is a common gynecological disorder that can cause musculoskeletal symptoms and manifest as nonspecific low back pain.

Case Description: The patient was a 25-year-old woman who reported the sudden onset of severe left-sided lumbosacral, lower quadrant, buttock, and thigh pain. The physical therapist examination revealed findings suggestive of a pelvic visceral disorder during the diagnostic process. The physical therapist referred the patient for medical consultation, and she was later diagnosed by a gynecologist with endometriosis and a left ovarian cyst.

Outcomes: The patient underwent laser laparoscopy and excision of the ovarian cyst followed by a regimen of gonadotropin-releasing hormone agonists. The intervention resulted in abolition of the lower quadrant pain and a significant reduction of the back and leg pain that enabled the patient to return to her normal activities.

Discussion: A thorough physical therapist examination that considers all of the musculoskeletal, visceral, and psychosocial components is essential to identify pelvic disorders such as endometriosis and other disease processes during the differential diagnosis of nonspecific low back pain. Medical consultation is necessary to provide proper diagnosis and intervention of endometriosis, but physical therapists also may have an important role in the identification of endometriosis and the management of the musculoskeletal aspects of the disorder.