Physical Medicine and Rehabilitation for Osteitis Pubis Treatment & Management

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

Rehabilitation Program

Physical Therapy

Rest and time are the primary healing mechanisms. Physical therapy (PT) may be useful during the early stage. Modalities, such as heat or ice, may provide symptomatic relief. Progressive ambulation with the aid of an assistive device (eg, cane, crutches) and possible orthoses (eg, lumbar/sacral corset, sacroiliac belt) to unload the pelvis for pain relief and to maintain correct anatomical alignment may be necessary.[7]

Avoidance of any therapeutic exercise that may place stress on the pelvic ring is prudent. A home exercise program that includes pelvic tilts may be prescribed. Experienced therapists may attempt dynamic stabilization techniques.

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Surgical Intervention

Different surgical approaches have been described, including curettage, arthrodesis, wedge resection, and wide resection.[7, 8] A report by Radic and Annear suggested that curettage is an effective treatment for athletes with osteitis pubis in whom nonoperative therapy has been unsuccessful.[9] The investigators found that 21 of the study's 23 athletes were able to run without pain one and a half to 6 months following curettage of the pubis symphysis, while 17 of them returned to training two and half to 7 months after the procedure, and 16 of the athletes resumed full activity two and a half to 12 months after curettage.

Wedge resection of the pubis symphysis is another technique that can be performed on patients in whom conservative management has failed; however, the natural progression of osteitis pubis may require months, and in some cases years, to improve. Surgical intervention is associated with early improvement of symptoms but may lead to later posterior pelvic instability. This instability may then require a second surgical procedure for stabilization.

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Other Treatment

  • Manipulation is performed in some instances to correct anterior translation of the symphysis.
  • Intra-articular glucocorticoid injections are controversial.
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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

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  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].

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  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].

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  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].

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

 
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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.
 
 
 
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