Diagnostic Considerations
The only real diagnostic pitfall in the management of osteitis pubis is missing a medical condition during the evaluation. 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 (see Presentation), along with ordering baseline laboratory and imaging studies (see Workup).
In the adolescent and young adult population, it is important to rule out gynecologic complications. Tubal pregnancies and pelvic inflammatory disease (PID) can often present as groin or suprapubic pain, though patients with these conditions usually appear acutely ill, whereas patients with osteitis pubis do not. In rare situations, prostatitis in male athletes and prostate cancer in older males can present with pubic pain. These conditions must be excluded in the initial clinical evaluation.
In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:
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Abdominal muscle pull
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Acetabular labral tears
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Bursitis
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Chronic symphyseal injury
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Groin strain
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Inguinal hernia
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Ischial intersection syndrome
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Muscle contusions
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Pelvic and hip fracture
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Pubic stress fracture
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Reiter syndrome (rare)
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Snapping hip syndrome
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Sports hernia
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Tendon injuries
Differentials
Ankylosing spondylitis (rare)
Urinary tract infection, Female
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Radiograph in 19-year-old athlete who presented with 3-week history of groin pull that was not resolving. On clinical examination, pubic spring test reproduced patient's pain, and radiograph was obtained. This image shows classic sclerosis and lysis findings of osteitis pubis around pubic symphysis, with widening of symphysis.
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Magnetic resonance image (MRI) from 20-year-old National Hockey League (NHL) player who presented with complaint of pain in testicles, which was worse with skating and with performing off-ice plyometric conditioning. MRI of pelvis combined with history and physical examination indicated diagnosis of osteitis pubis.
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Pelvis, frontal view.
