Physical Medicine and Rehabilitation for Osteitis Pubis
- Author: Kelly L Allen, MD; Chief Editor: Consuelo T Lorenzo, MD more...
Background
Since 1924, osteitis pubis has been known as a noninfectious inflammation of the pubis symphysis (also known as the pubic symphysis, symphysis pubis, or symphysis pubica; seen in the image below) causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery and remains a well-known complication of invasive procedures about the pelvis. However, it may occur as an inflammatory process in athletes. The incidence and etiology of osteitis pubis as an inflammatory process versus an infectious process continues to fuel debate among physicians when confronted by a patient who presents complaining of abdominal pain or pelvic pain and overlapping symptoms.
Pelvis, frontal view. Recent studies
In an Australian study, Gabbe et al sought to determine whether hip and groin injuries sustained by players in the Australian Football League (AFL) could be associated with earlier injuries suffered in "elite junior football." Analyzing data from 502 AFL players, including 161 who had sustained a hip/groin injury during their career with the league, the authors found that players who had had a hip or groin injury during their time in elite junior football had a nearly 4-fold greater chance of missing AFL games due to osteitis pubis than did other players (as well as a 9.59 times greater chance of missing games owing to a hip chondral/labral lesion).[1]
Pathophysiology
Osteitis pubis is thought to result from inflammation of the pubis symphysis and, as demonstrated in the image below, is characterized by sclerosis and bony changes of the pubis symphysis.[2]
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. Epidemiology
Frequency
United States
No available statistics are found in the literature for this condition.
International
No available international data exist; however, osteitis pubis may be more common in Europe due to the popularity of kicking sports such as soccer.
Mortality/Morbidity
While rare instances of mortality have been reported in the obstetric literature from femoral artery involvement, morbidity is observed more commonly secondary to pain and difficulty with ambulation.
Sex
The literature suggests that osteitis pubis is more prevalent in men. However, as women continue to lead more active lifestyles, and become more involved in sports such as soccer, the incidence and prevalence of the condition may change.
Age
Although osteitis pubis can affect all age groups, it is rarely encountered in the pediatric population. The disorder occurs most commonly in men aged 30-50 years. Women are more frequently affected in their mid-30s.
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