Patients with osteitis pubis present with pain in the anterior and medial groin.
Patients with osteitis pubis present with pain in the anterior and medial groin. Osteitis pubis is seen most frequently in kicking and cutting activities, which make incidence higher in sports like soccer and rugby. Other causes of osteitis pubis include vaginal delivery, urologic surgery, and autoimmune conditions.
The pubic symphysis is not a synovial joint and only allows a small amount of motion and is located at the junction of the pubic bones. The ends of the pubic bones are lined with hyaline cartilage and there is a fibrocartilaginous disc between the bones. Hollow arrow shoes the pubic symphysis Injury to the pubic symphysis occurs due to repetitive muscular strain across the pubic bone.
The pubic bone is the attachment of the rectus abdominus and adductor longus. Osteitis pubis involves injury to both the pubic symphysis and the adjacent parasymphyseal bone. During childbirth, there is disruption of the ligaments supporting the pubic symphysis, which destabilize the symphysis and lead to the findings of osteitis pubis.
Muscle attachments affecting pubic symphysis The physical exam of osteitis pubis is supported by provoking pain by pushing on the pubic symphysis and also the adjacent pubic ramus. Complicating diagnosis is patients will also have reduced motion of the hip joint on exam. Stages of osteitis pubis Radiographs can be done to evaluate the pubic symphysis.
A “flamingo view” can be done, where the patient bears weight alternately on each leg and the image is positive if there is vertical pubic subluxation >2mm and degenerative changes. Subchondral cysts and osteophytes can also be seen on radiographs. Flamingo view of pelvis An MRI can also confirm osteitis pubis.
If you are experiencing symptoms that may be related to osteitis pubis, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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