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Osteitis Pubis
Aka: Osteitis Pubis, Pubic Symphysis Disruption, Symphysis Pubis Disruption, Symphysis Pubis Separation, Symphysis Pubis Subluxation, Pubic Symphysis Diastasis
- See Also
- Hip Pain
- Epidemiology
- Common cause of chronic Groin Pain in athletes
- Causes
- Pregnancy
- Sports Injury
- Long distance Running
- Soccer
- Pathophysiology
- Pregnancy
- Expanding pressure from growing fetus
- Sports-related repetitive stress injuries
- Overuse of hip adductors and gracilis Muscle
- Shearing forces on Pubic Symphysis
- Traction on pelvic musculature
- Risk Factors: Predisposing factors in sports
- Limited internal hip rotation
- Sacroiliac joint fixation
- Lower limb biomechanical abnormalities (postulated)
- Leg Length Discrepancy
- Over-pronation
- Genu Varum (Varus knee deformity)
- Genu Valgum (Valgus knee deformity)
- Symptoms
- Groin Pain of gradual onset and progression
- Exercise-induced pain
- Adductor pain in medial thigh (80%)
- Pubic Symphysis pain (40%)
- Lower Abdominal Pain (30%)
- Hip Pain (12%)
- Referred Scrotal Pain (8%)
- Signs
- Tenderness to palpation of Pubic Symphysis
- Provocative maneuvers
- Active adduction (distal symphysis involvement)
- Sit-ups (proximal symphysis involvement)
- Imaging (non-pregnant patients)
- XRay (changes often seen in asymptomatic athletes)
- Widened Pubic Symphysis
- Irregular articular surface
- Periarticular sclerosis
- Isotope bone scan
- Increased uptake at Pubic Symphysis
- Poor Test Sensitivity
- MRI (preferred study)
- Early: Marrow edema
- Later: Low signal uptake on T1 and T2-weighted images
- Differential Diagnosis
- See Groin Injuries in Athletes
- Adductor Strain
- Osteomyelitis of the Pubic Symphysis
- Spontaneous onset following surgery near Pelvis
- Management: Athlete
- Avoid provocative activities
- Cross training with pain-free Exercise
- Physical Therapy
- Hip Range of Motion
- Adductor Stretching and strengthening
- Correct biomechanical abnormalities
- Leg Length Discrepancy
- Over-pronation
- Consider local Corticosteroid Injection in acute cases
- Prognosis
- Complete resolution may require 9-12 months
- References
- Schleihauf (2019) Crit Dec Emerg Med 33(5): 19-28
- Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]
- Fricker (1991) Sports Med 12:266-79 [PubMed]