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

Osteitis Pubis

Author: Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
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: Jan 24, 2007

Introduction

Background

Since 1924, osteitis pubis has been known as a noninfectious inflammation of the pubis symphysis 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.

Pathophysiology

Osteitis pubis is thought to result from inflammation of the pubis symphysis and is characterized by sclerosis and bony changes of the pubis symphysis.

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 lead more active lifestyles, including a greater involvement in sports such as soccer, the incidence and prevalence may change.

Age

Osteitis pubis can affect all age groups. This condition rarely is encountered in the pediatric population. Osteitis pubis occurs most commonly in men aged 30-50 years. Women are affected more in their mid 30s.

Clinical

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 one 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.

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.

Causes

  • Pregnancy/childbirth
  • Gynecologic surgery
  • Urologic surgery
  • Athletic activities (eg, running, football, soccer, ice hockey, tennis)
  • Major trauma
  • Repeated minor trauma
  • Rheumatological disorders
  • Unknown etiology

More on Osteitis Pubis

Overview: Osteitis Pubis
Differential Diagnoses & Workup: Osteitis Pubis
Treatment & Medication: Osteitis Pubis
Follow-up: Osteitis Pubis
References
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References

  1. 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].

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

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

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

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

  6. 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].

  7. Lovell G, Galloway H, Hopkins W. 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.

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

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

  10. 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].

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

  12. 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].

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

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Further Reading

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Keywords

osteitis pubis, pubis symphysis separation, symphyseal separation, pubis diathesis, gracilis syndrome

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Contributor Information and Disclosures

Author

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
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, MS, MD, Medical Director, Rehabilitation Hospital, Assistant Professor of Orthopaedics and Rehabilitation, Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center
Everett C Hills, MS, MD 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, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Associate 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: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
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.

 
 
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