Follow-up
Return to Play
Return to play ideally occurs once the patient is pain free with all activity; however, the athlete often returns to play when there is minimal pain with the aggravating activity. This is often acceptable because the disease is usually self-limited and resolves in 6-12 months. Note, however, that although recurrence rates are as high as 25%, the athlete often experiences residual pain that does not require activity modification.2 The importance of flexibility training must be stressed for the athlete to be able to continue full activity.
Related Medscape topic:
Resource Center Exercise and Sports Medicine
Complications
Complications of osteitis pubis are minimal and few are reported. The major complication is a muscle-tendon injury of the adductor muscles due to muscle tightness. This complication is often prevented with correction of the biomechanical errors that caused the condition and flexibility training. A major complication of a misdiagnosed osteomyelitis is erosion of bone, which may take a very long time to remodel.
Prevention
Again, flexibility in athletes is the most important step toward prevention of osteitis pubis. Proper body mechanics must be stressed in athletes who participate in activities that yield a higher incidence of this condition. Aggressively treat SI dysfunction in running and skating athletes so that the pubic symphysis does not become the victim of poor pelvic mechanics. In addition, early recognition of symptoms can prevent chronic and more severe symptoms.
Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Pain Management: Advanced Approaches to Chronic Pain Management
Resource Center Pain Management: Pharmacologic Approaches
Prognosis
The prognosis for osteitis pubis is very good. The condition resolves with rest in most cases. As stated by Holt et al, more aggressive therapy is often needed when the athlete refuses to modify activities or rest.17 With aggressive physical therapy and judicious use of medications, the athlete often returns to the previous level of activity.
Education
The most important information to present to athletes and coaches is the importance of flexibility training. This must become part of the athlete's daily routine. In addition, the athlete, coaches, and athletic trainers must understand that early identification and treatment of osteitis pubis are crucial.13 Any groin pull that does not resolve or show marked improvement in 5-7 days should be referred to the team physician. The entire sports medicine team needs to not only maintain a high index of suspicion, but also be thorough in the evaluation of groin pain.
Miscellaneous
Medicolegal Pitfalls
- The only pitfall to osteitis pubis treatment is to miss a medical condition during the evaluation (see Differentials and Other Problems to Be Considered, above). Genitourinary diagnoses are the most likely to be missed. Obtaining a thorough patient history and performing a physical examination should help the physician rule out other conditions. Ordering baseline laboratory studies and radiographs is often prudent to prevent missing these diagnoses (See Workup, above).
Related Medscape topic:
Resource Center Medical Malpractice and Legal Issues
Special Concerns
- In the adolescent and young adult population, rule out gynecologic complications. Tubal pregnancies and PID can often present as groin or suprapubic pain, although patients with these conditions usually appear acutely ill, whereas patients with osteitis pubis do not.
- Prostatitis in male athletes and prostate cancer in older males can rarely present with pubic pain. These conditions must be excluded on the initial clinical evaluation.
Related Medscape topics:
Resource Center Genital Herpes
Resource Center HPV and Cervical Cancer
Resource Center Women's Sexual Health
More on Osteitis Pubis |
| Overview: Osteitis Pubis |
| Differential Diagnoses & Workup: Osteitis Pubis |
| Treatment & Medication: Osteitis Pubis |
 Follow-up: Osteitis Pubis |
| Multimedia: Osteitis Pubis |
| References |
| « Previous Page | Next Page » |
References
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Further Reading
Keywords
pubic instability, pubic symphysitis, pubalgia, traumatic aseptic osteitis pubis, Pierson syndrome, chondritis pubis, posttraumatic osteonecrosis of the pubis, groin pain, groin pull, groin injury
