II. Epidemiology

  1. Common cause of chronic Groin Pain in athletes

III. Causes

  1. Pregnancy
  2. Sports Injury
    1. Long distance Running
    2. Soccer

IV. Pathophysiology

  1. Pregnancy
    1. Expanding pressure from growing fetus
  2. Sports-related repetitive stress injuries
    1. Overuse of hip adductors and gracilis Muscle
    2. Shearing forces on Pubic Symphysis
    3. Traction on pelvic musculature

V. Risk Factors: Predisposing factors in sports

  1. Limited internal hip rotation
  2. Sacroiliac joint fixation
  3. Lower limb biomechanical abnormalities (postulated)
    1. Leg Length Discrepancy
    2. Over-pronation
    3. Genu Varum (Varus knee deformity)
    4. Genu Valgum (Valgus knee deformity)

VI. Symptoms

  1. Groin Pain of gradual onset and progression
  2. Exercise-induced pain
    1. Adductor pain in medial thigh (80%)
    2. Pubic Symphysis pain (40%)
    3. Lower Abdominal Pain (30%)
    4. Hip Pain (12%)
    5. Referred Scrotal Pain (8%)

VII. Signs

  1. Tenderness to palpation of Pubic Symphysis
  2. Provocative maneuvers
    1. Active adduction (distal symphysis involvement)
    2. Sit-ups (proximal symphysis involvement)

VIII. Imaging (non-pregnant patients)

  1. XRay (changes often seen in asymptomatic athletes)
    1. Widened Pubic Symphysis
    2. Irregular articular surface
    3. Periarticular sclerosis
  2. Isotope bone scan
    1. Increased uptake at Pubic Symphysis
    2. Poor Test Sensitivity
  3. MRI (preferred study)
    1. Early: Marrow edema
    2. Later: Low signal uptake on T1 and T2-weighted images

IX. Differential Diagnosis

  1. See Groin Injuries in Athletes
  2. Adductor Strain
  3. Osteomyelitis of the Pubic Symphysis
    1. Spontaneous onset following surgery near Pelvis

X. Management: Athlete

  1. Avoid provocative activities
  2. Cross training with pain-free Exercise
  3. Physical Therapy
    1. Hip Range of Motion
    2. Adductor Stretching and strengthening
  4. Correct biomechanical abnormalities
    1. Leg Length Discrepancy
    2. Over-pronation
  5. Consider local Corticosteroid Injection in acute cases

XI. Prognosis

  1. Complete resolution may require 9-12 months

XII. References

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Osteitis of pelvic region (C0221010)

Concepts Disease or Syndrome (T047)
SnomedCT 75564005
English osteitis pubis, osteitis pubis (diagnosis), pubis osteitis, Osteitis pubis, Osteitis of pelvic region, Osteitis of pelvic region (disorder)
Spanish osteítis de la región pélvica (trastorno), osteítis de la región pélvica, osteítis del pubis

Ontology: Pubic Symphysis Diastasis (C0238442)

Definition (MSH) Separation of the PUBIC SYMPHYSIS. It is an uncommon complication of CHILDBIRTH causing postpartum PAIN, but it can also arise from other causes.
Concepts Injury or Poisoning (T037)
MSH D046548
SnomedCT 41766008, 199987009, 263012009, 61007003
Swedish Bäckenlösning
English Symphysis pubis diastasis, separation of symphysis pubis (diagnosis), separation of symphysis pubis, Symphysiolysis of symphysis pubis, Symphysiolysis, Pubic Symphysis Diastasis, Pubic Symphysis Diastasis [Disease/Finding], symphysis pubis separation, diastasis symphysis pubis, pubis symphysis diastasis, pubic separation symphysis, symphysis pubis diastasis, pubic symphysis separation, pubis symphysis separation, pubis separation symphysis, Dislocation of symphysis pubis (diagnosis), Dislocation of symphysis pubis, Pubic symphysis separation, Separation of symphysis pubis, Symphysis pubis separation, Diastasis of symphysis pubis, Dislocation of symphysis pubis (disorder), Symphysiolysis of symphysis pubis (disorder), dislocation; symphysis pubis, separation; symphysis pubis, symphysis pubis; dislocation, symphysis pubis; separation, Diastases, Pubic Symphysis, Diastases, Symphysis Pubis, Diastasis, Pubic Symphysis, Diastasis, Symphysis Pubis, Pubic Symphysis Diastases, Symphysis Pubis Diastases, Symphysis Pubis Diastasis, Symphysis Pubis, Diastasis, Diastasis Symphysis Pubis
Czech spona stydká - diastáza, symphysis pubica - diastáza
Finnish Symfysiolyysi
Japanese 恥骨結合離開
Polish Rozejście się spojenia łonowego
Norwegian Bekkenløsning
Dutch luxatie; symphysis pubica, separatie; symphysis pubica, symphysis pubica; luxatie, symphysis pubica; separatie, Diastase symphysis pubis, Symphysis pubis, diastase
Spanish diastasis de la sínfisis púbica (trastorno), diastasis de la sínfisis púbica, separación de la sínfisis del pubis, separación de la sínfisis pubiana (trastorno), separación de la sínfisis pubiana, sinfisiólisis de la sínfisis del pubis (trastorno), sinfisiólisis de la sínfisis del pubis, Diastasis de la Sinfisis Pubiana
French Diastasis de la symphyse pubienne
German Diastase der Schambeinfuge, Diastase, Symphysis pubica-, Diastasis symphysis pubica, Schambeinfugen-Diastase, Symphysis pubica-Diastase
Italian Diastasi della sinfisi pubica
Portuguese Diástase da Sínfese Pubiana