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Updated: Jun 1 2021

Osteitis Pubis

Images xray_moved.jpg osteitis.jpg of ps.jpg and inferior ligaments .jpg and posterior.jpg
  • summary
    • Osteitis pubis is the inflammation of the pubic symphysis caused by repetitive trauma that most commonly occurs during sports involving repetitive kicking or hip abduction/adduction. 
    • Diagnosis is made clinically with localized pain over the pubic symphysis with radiographs showing osteolytic pubis with bony erosions and often times diastasis of the symphysis.
    • Treatment is nonoperative with rest, NSAIDs and activity modification. 
  • Epidemiology
    • Demographics
      • common in soccer, hockey, football and running
  • Etiology
    • 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
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