Physical Medicine and Rehabilitation for Osteitis Pubis Clinical Presentation

  • Author: Kelly L Allen, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jun 22, 2010
 

History

  • Pain generally is localized over the symphysis and may radiate to the groin, medial thigh, or abdomen.
    • Onset can be abrupt or insidious (more than 1 mo).
    • Pain is exacerbated by activities such as running, pivoting on 1 leg, and kicking.
    • Lying on one's side also may exacerbate the pain.
    • Pain can occur with walking, climbing stairs, coughing, or sneezing.
  • The patient may experience a sensation of clicking or popping when rising from a seated position, turning over in bed, or walking on uneven ground.
  • The patient may report weakness and difficulty ambulating.
Next

Physical

  • Tenderness to palpation is noted directly over the pubis symphysis with bilateral compression of the greater trochanters.
  • The patient may report weakness, chiefly in the hip adductors, but there also may be involvement within the hip flexors.
  • A waddling gait may be observed.
Previous
Next

Causes

  • Pregnancy/childbirth
  • Gynecologic surgery
  • Urologic surgery
  • Athletic activities (eg, running, football, soccer, ice hockey, tennis)[3]
  • Major trauma
  • Repeated minor trauma
  • Rheumatologic disorders
  • Unknown etiology
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Coauthor(s)

Guy W Fried, MD  Assistant Professor, Department of Rehabilitation Medicine, Thomas Jefferson University; Outpatient Medical Director, Medical Director of Incontinence and Respiratory Care Programs, Magee Rehabilitation Hospital

Guy W Fried, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Everett C Hills, MD, MS  Vice Chair, Department of Physical Medicine and Rehabilitation, Medical Director for Outpatient Services, Penn State Hershey Rehabilitation Hospital, Assistant Professor of Physical Medicine and Rehabilitation, Assistant Professor of Orthopaedics and Rehabilitation, Penn State Milton S Hershey Medical Center and Penn State University College of Medicine

Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Association of Academic Physiatrists, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

  1. Gabbe BJ, Bailey M, Cook JL, et al. The Association Between Hip and Groin Injuries in The Elite Junior Football Years and Injuries Sustained During Elite Senior Competition. Br J Sports Med. Dec 2 2009;[Medline].

  2. Robertson BA, Barker PJ, Fahrer M, et al. The anatomy of the pubic region revisited: implications for the pathogenesis and clinical management of chronic groin pain in athletes. Sports Med. 2009;39(3):225-34. [Medline].

  3. Garvey JF, Read JW, Turner A. Sportsman hernia: what can we do?. Hernia. Feb 2010;14(1):17-25. [Medline].

  4. Zoga AC, Kavanagh EC, Omar IM, et al. Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. Jun 2008;247(3):797-807. [Medline]. [Full Text].

  5. Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. Jan 2008;36(1):117-21. [Medline].

  6. Lovell G, Galloway H, Hopkins W, et al. Osteitis pubis and assessment of bone marrow edema at the pubic symphysis with MRI in an elite junior male soccer squad. Clin J Sport Med. Mar 2006;16(2):117-22. [Medline].

  7. Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. Sep 30 2008;[Medline].

  8. Mehin R, Meek R, O'Brien P, et al. Surgery for osteitis pubis. Can J Surg. Jun 2006;49(3):170-6. [Medline]. [Full Text].

  9. Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. Jan 2008;36(1):122-8. [Medline].

  10. Andrews SK, Carek PJ. Osteitis pubis: a diagnosis for the family physician. J Am Board Fam Pract. Jul-Aug 1998;11(4):291-5. [Medline].

  11. DiStefano VJ, Nixon JE. Osteitis pubis--a case of housemaid's pubis?. Pa Med. Jan 1972;75(1):51-2. [Medline].

  12. Fon LJ, Spence RA. Sportsman's hernia. Br J Surg. May 2000;87(5):545-52. [Medline].

  13. Fricker PA, Taunton JE, Ammann W. Osteitis pubis in athletes. Infection, inflammation or injury?. Sports Med. Oct 1991;12(4):266-79. [Medline].

  14. Harris NH, Murray RO. Lesions of the symphysis in athletes. Br Med J. Oct 26 1974;4(5938):211-4. [Medline].

  15. Holmgren G. The treatment of osteitis pubis with anticoagulants. A report of three cases in Africans. Cent Afr J Med. Jan 1972;18(1):10-2. [Medline].

  16. Michiels E, Knockaert DC, Vanneste SB. Infectious osteitis pubis. Neth J Med. Jun 1990;36(5-6):297-300.

  17. Moore RS, Stover MD, Matta JM. Late posterior instability of the pelvis after resection of the symphysis pubis for the treatment of osteitis pubis. A report of two cases. J Bone Joint Surg Am. Jul 1998;80(7):1043-8. [Medline].

  18. Pizzarello LD, Golden GT, Shaw A. Acute abdominal pain caused by osteitis pubis. Am Surg. Nov 1974;40(11):660-1. [Medline].

  19. Vincent C. Osteitis pubis [published erratum appears in J Am Board Fam Pract 1993 Nov-Dec;6(6):616]. J Am Board Fam Pract. Sep-Oct 1993;6(5):492-6. [Medline].

  20. Wiley JJ. Traumatic osteitis pubis: the gracilis syndrome. Am J Sports Med. Sep-Oct 1983;11(5):360-63. [Medline].

 
Previous
Next
 
Radiograph in a 19-year-old athlete who presented with a 3-week history of a groin pull that was not resolving. This radiograph shows the classic sclerosis and lysis findings of osteitis pubis around the pubis symphysis, with widening of the symphysis.
Pelvis, frontal view.
Magnetic resonance imaging (MRI) scan from a 20-year-old National Hockey League (NHL) player who presented with a complaint of testicle pain, which became worse with skating and with the performance of off-ice plyometric conditioning. The MRI scan of the player's pelvis, combined with the patient's history and physical examination, indicated a diagnosis of osteitis pubis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.