eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Osteitis Pubis: Differential Diagnoses & Workup

Author: Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
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
Contributor Information and Disclosures

Updated: Jul 28, 2009

Differential Diagnoses

Adductor Strain

Other Problems to Be Considered

Osteomyelitis of the pubis symphysis
Ischial intersection syndrome
Snapping hip syndrome
Stress fracture
Groin strain
Pelvic and hip fracture
Muscle contusions
Tendon injuries
Acetabular labral tears
Bursitis
Chronic symphyseal injury

Workup

Laboratory Studies

  • Laboratory studies are not required to make the diagnosis, but some authorities suggest testing for an elevated WBC count and/or erythrocyte sedimentation rate. This testing may eliminate other causes.

Imaging Studies

  • Plain radiographs
    • Plain radiographs demonstrate sclerosis, cystic changes, or rarefaction of the medial portions of the pubic rami (ie, marginal irregularity).
    • Instability is defined as more than 2 mm of cephalad translation of the superior pubic ramus on each side, with the patient standing on 1 leg in turn.
    • Widening of the cleft usually is measured to greater than 10 mm.
    • The sacroiliac joints also should be evaluated since laxity of one or both may contribute to pubis symphysis instability.
    • Positive findings usually are not apparent until 4 weeks after the onset of symptoms.
  • Bone scans may be negative but can demonstrate intense signal uptake at the pubis symphysis.
  • Ultrasonography may show abnormal widening of the cleft.
  • Computed tomography (CT) scanning is also used for evaluation of the pubis symphysis and the posterior pelvic ring.
  • Magnetic resonance imaging (MRI) studies2,3 may indicate bone marrow edema at the pubis symphysis, but this finding may also be seen in asymptomatic individuals.4 (See image below and Image 3.)


Magnetic resonance imaging (MRI) scan from a 20-y...

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.

[ CLOSE WINDOW ]
Magnetic resonance imaging (MRI) scan from a 20-y...

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.

More on Osteitis Pubis

Overview: Osteitis Pubis
Differential Diagnoses & Workup: Osteitis Pubis
Treatment & Medication: Osteitis Pubis
Follow-up: Osteitis Pubis
Multimedia: Osteitis Pubis
References
Further Reading
[ CLOSE WINDOW ]

References

  1. 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].

  2. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

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

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

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

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

  13. 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].

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

  15. 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].

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

  17. 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].

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

[ CLOSE WINDOW ]

Further Reading

Related eMedicine articles:
Adductor Strain
Groin Injury
Osteitis Pubis [Sports Medicine]

[ CLOSE WINDOW ]

Keywords

osteitis pubis, pelvic pain, groin pain, pubis, osteitis, symphysis, pubic symphysis, pubis symphysis, symphysis pubis, symphysis pubica, symphysis dysfunction, pubis dysfunction, symphyseal separation, pubis diathesis, gracilis syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
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.

Medical Editor

Everett C Hills, MD, MS, Medical Director, Penn State Hershey Rehabilitation Hospital, Assistant Professor of Orthopaedics and Rehabilitation, Assistant Professor of Neurology, 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, 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

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, 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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.