Differential diagnosis of endometriosis in patient with nonspecific low back pain: A case report

• DOI: 10.1016/j.jbmt.2021.02.019
• Publication Date: 2021-03-07T12:39:17Z
• Authors: Chiara Cricco; Antonella Daugenti; Domenico Angilecchia; Daniele Ceron
• Keywords: Medical History; Back Pain; Manual therapy; Case presentation; Presentation (obstetrics)

Abstract Background Endometriosis is one of the most widespread gynecological disorders and a very common condition amongst fertile women, thus it has to be considered one of the possible sources of lumbopelvic pain. Endometriosis is commonly related to low back pain (LBP) and therefore often mistaken for a musculoskeletal disorder. The purpose of this case report is to underline the primary role of clinical reasoning and assessment process, which led the physiotherapist to the differential diagnosis, considering endometriosis among the possible causes of low back pain. Case presentation S.C, 45 years old, complained to physiotherapist of lumbar spine and left buttock pain, spreading to the hypogastric, inguinal and left pubic areas. The patient's past medical history included gynecological visceral disorders, regularly monitored. Functional evaluation and clinical tests revealed a disorder referred to the lumbar spine and sacroiliac region. Initial physical therapy management included education, manual therapy and therapeutic exercise. Nevertheless, after five treatment sessions, the symptoms remained unchanged, and therefore the patient was referred to a gynecologist for a consultation. The patient underwent a laparoscopy for endometriosis eradication and the intervention resulted in complete abolition of symptoms, enabling the patient to return to work and to do physical activities. Conclusions this case report highlights the importance of a thorough clinical assessment and the identification of relevant findings from patient's medical history to be carried out by the physiotherapist. Those are of crucial importance to make an appropriate differential diagnosis and to screen amongst the possible causes of lumbopelvic pain also visceral ones as endometriosis, which often manifests with associated symptoms such as nonspecific LBP.