Updated: 10/6/2016

Osteitis Pubis

Topic
Review Topic
0
0
Questions
2
0
0
Evidence
2
0
0
https://upload.orthobullets.com/topic/3093/images/AP xray_moved.jpg
https://upload.orthobullets.com/topic/3093/images/moi osteitis.jpg
https://upload.orthobullets.com/topic/3093/images/anatomy of ps.jpg
https://upload.orthobullets.com/topic/3093/images/illustration.jpg
https://upload.orthobullets.com/topic/3093/images/superior and inferior ligaments .jpg
https://upload.orthobullets.com/topic/3093/images/anteror and posterior.jpg
Introduction
  • Inflammation of the pubic symphysis caused by repetitive trauma
  • Epidemiology
    • demographics
      • common in soccer, hockey, football and running
  • Pathophysiology
    • mechanism 
      • repetitive microtrauma to the pubic symphysis by
        • sports involving repetitive kicking  
        • sports involving hip repetitive adduction/abduction
Anatomy
  • Pubic symphysis
    • osteology
      • located at the anterior articulation between each hemipelvis
      • composed of articular cartilage-covered rami separated by fibrocartilage disc 
    • muscles
      • regional attachments 
      • adductors
        • adductor magnus 
        • adductor brevis 
        • adductor longus 
        • gracilis 
      • rectus abdominis
      • pectineus 
    • ligaments
      • superior pubic ligament 
      • inferior pubic ligament
      • anterior pubic ligament  
      • posterior pubic ligament
    • biomechanics
      • very stable joint
      • strong ligamentous support limits motion
Presentation
  • Symptoms
    • vague, ill-defined pain is anterior pelvic region
      • worse with activities involving hip adduction/abduction at the anterior pelvis
      • may have spasms with hip adduction
  • Physical exam
    • palpation
      • localized tenderness directly over the pubic symphysis
Imaging
  • Radiographs 
    • recommended views
      • AP of pelvis 
    • findings
      • AP pelvis shows osteolytic pubis with bony erosions and often times diastasis of the symphysis 
      • degenerative changes within the joint can be seen
  • MRI
    • bone marrow edema found early  
  • Bone scan
    • increased activity in area of pubic symphysis 
Differential
  • Athletic pubalgia 
  • Stress fracture of the pubic rami
  • Stress fracture of the femoral neck
  • Inguinal hernia
  • Oncologic disease (rare)
Treatment
  • Nonoperative
    • NSAIDS, rest, activity modification
      • indications
        • treatment for vast majority of cases
      • modalities
        • steroid injections are controversial
      • outcomes
        • self-limiting process which usually resolves with non-operative treatment
          • may take several months to resolve
 

Please rate topic.

Average 4.0 of 22 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ10.87) A 26-year-old rugby player has been having progressive anterior pelvic pain for the last 3 months. He is diagnosed with osteitis pubis, and a non-operative treatment regimen is initiated. Which of the following figures represents this patients diagnosis? Review Topic

QID: 3175
FIGURES:
1

Figure A

3%

(67/2267)

2

Figure B

2%

(38/2267)

3

Figure C

92%

(2081/2267)

4

Figure D

1%

(24/2267)

5

Figure E

2%

(51/2267)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3
ARTICLES (2)
Topic COMMENTS (0)
Private Note