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Osteitis Pubis

Topic updated on 05/02/15 10:45am
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

 

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(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? Topic Review Topic
FIGURES: A   B   C   D   E  

1. Figure A
2. Figure B
3. Figure C
4. Figure D
5. Figure E

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