Osteitis Pubis Research Articles

Osteitis Pubis in Athletes

Osteitis pubis is one of many etiologies of groin pain in athletes. It is a painful overuse injury of the pubic symphysis and the parasymphyseal bone that typically is found in athletes whose sports involve kicking, rapid accelerations, decelerations, and abrupt directional changes. Athletes most commonly present with a complaint of anterior and/or medial groin pain but also can present with lower abdominal, adductor, inguinal, perineal, and/or scrotal pain. Symptoms can be severe and can limit participation in sport until treatment is instituted. Imaging is useful for ruling out other etiologies of groin pain, identifying concomitant pathology, and confirming the diagnosis itself. Treatment is varied but usually includes nonoperative measures of rest, rehabilitation, and/or pharmacotherapy and also may include injections and/or surgical procedures. A high clinical suspicion should exist when evaluating soccer, rugby, or American football players and distance runners who present with complaints of groin pain.

Pelvic stress injuries in a small‐bodied forager

AbstractThe assumption of natural selection for obstetric adequacy would predict the occasional discovery of skeletal evidence for inadequacy, yet such cases are rare. Here stress injuries to the pelvic ring are associated with an asymmetrical pelvis caused by partial agenesis of the right sacral costal process. The small, middle‐aged woman lived about 2000 years ago and pursued a physically vigorous life as a coastal forager on the South African Cape coast. The right sacral costal process (ala) is about 5 mm narrower than the left. This sacral hemiagenesis led to pelvic asymmetry, and concomitant instability. The six articular faces of the pelvis show the normal surfaces replaced by disorganised, porous new bone and extensive eburnation. The left pubic face shifted dorsally, making contact with the ventral aspect of the right pubis. The most distinctive aspect is the presence of osteitis pubis, or pubic symphysis stress injury, which is clinically associated both with difficult childbirth and with vigorous athletic activities. Adjustments to the altered pelvis include erosions and osteophytes at sites of ligament attachment, and prominent bilateral insertion areas on the tibiae for the stabilising iliotibial band. While habitual activities may explain some pelvic features, such as the bilateral bevelling of the acetabular borders, it is postulated that childbirth exacerbated the joint instability and the subsequent deterioration. This case joins a small literature on the condition of pubic symphysis stress injury, and illustrates the mechanisms through which natural selection for pelvic size and shape characteristics may have occurred. Copyright © 2010 John Wiley & Sons, Ltd.

Results of Simplified Urethropexy in the Recovery of Continence After Radical Laparoscopic Prostatectomy

To analyze the effectiveness of simplified urethropexy in the evolution of urinary incontinence after radical laparoscopic prostatectomy. Between January 2007 and December 2008, 104 patients were included in a randomized trial to assess the effectiveness of simplified urethropexy. The simplified urethropexy technique was performed on conclusion of a urethrovesical anastomosis with running suture and, before cutting the suture material, a suture was applied using the same material with a needle through the pubic tubercle, tightening it and securing it with a Hem-o-lok. Fifty-one patients qualified for the trial in the simplified urethropexy group (group 1) and another 51 in the control group without urethropexy (group 2). Incontinence was defined as the lack of the need for protection for normal life, and the degree of continence was compared at 3, 6, and 12 months after surgery. Surgery lasted 141 minutes in group 1 and 139 in group 2 (NS). There were no secondary complications such as urine retention, osteitis pubis, or bladder perforation. After 3 months, 47.1% of patients in each group declared continence (NS). After 6 months, 72.6% of patients in group 1 and 66.7% in group 2 (P<0.05) declared continence. After 12 months, 92.2% of patients in group 1 and 84.3% in group 2 declared continence. In our experience, simplified urethropexy is a simple, nontime-consuming technique that shows a slight clinical improvement in continence within 6 and 12 months, without reaching significant differences with the Fisher Test. It would be necessary to perform a trial with a greater number of patients to confirm these data.

Treatment of Osteitis Pubis in Non-Athlete Female Patients

Background:Osteitis pubis represents a non-infectious inflammation of the pubic symphysis causing varying degrees of lower abdominal and pelvic pain. Although, the disease is believed to affect mainly young athletic patients, it is also encountered in other specific patient groups. Both conservative and surgical treatment options are available. While for elite athletes surgical treatment is indicated, leading to fast pain relief and mobilization, for non-athletic patients no clear indication can be established.Methods:Eight non-athletic women with osteitis pubis, referred to our Department for treatment, were evaluated. All were initially treated conservatively with bed rest, per os non steroidal anti-inflammatory drugs and physical therapy.Results:Seven patients improved significantly with conservative treatment while one displayed no improvement and was treated surgically with arthrodesis.Conclusion:We conclude that, for non-athletic female patients suffering from osteitis pubis, surgery is rarely required and that conservative treatment by means of non steroidal anti inflammatory drugs and physical modalities represents a fair option regarding pain and limitation of everyday activity.

Polymyxin B-Immobilized Fiber Hemoperfusion in a High School Football Player with Septic Shock Caused by Osteitis Pubis

A 17-year-old male high school football player treated by polymyxin B-immobilized fiber (PMX-F) hemoperfusion for mild-moderate septic shock caused by osteitis pubis is described in this study. He was admitted for inguinal pain, gait disturbance, and high fever (40.6°C). His white blood cell (WBC) count and C-reactive protein (CRP), endotoxin, and procalcitonin (PCT) levels were significantly elevated. His blood pressure was 76/46 mm Hg. Magnetic resonance imaging showed bone and muscle injury at the pubic symphysis. Septic shock with high blood endotoxin and PCT concentrations was diagnosed, and the patient was treated with antibiotics, γ-globulin, and dopamine on the admission day. However, the septic shock did not improve. On day 3, we performed direct hemoperfusion twice using a PMX-F column. After the second PMX-F treatment, the patient's temperature decreased to 37.0°C, and his WBC count, CRP levels, blood endotoxin, and PCT levels decreased. The inguinal pain diminished, and the patient's blood pressure increased to 112/76 mm Hg. He was discharged on day 10 after admission. This case reflects association of PMX-F with decreased endotoxin, PCT, and CRP, suggesting the association of PMX-F with clinical improvement in mild-moderate sepsis in a young athlete.

US in pubalgia

There is considerable confusion over the word “pubalgia” with regard to the definition and the etiological causes of this condition. The term pubalgia should be used to indicate disabling pain affecting the pubic region in people who practise sports. Pubalgia affects 10% of those who practise sports and it is particularly prevalent in football players. According to the literature, about 40% of cases of pubalgia are caused by overuse of the symphysis pubis with progressive lesions affecting the rectus abdominal muscles, adductors (rectal-adductor syndrome) and the symphysis itself (osteitis pubis and joint injury). An initial study of the tendons is carried out by ultrasound (US) whereas magnetic resonance imaging (MRI) should be performed to study the bones and joints. Another 40% of cases of pubalgia are caused by "sports hernia" defined as anteroinferior abdominal wall insufficiency. These alterations can only be identified at dynamic US examination. About 20% of cases of pubalgia are caused by diseases of the neighboring structures or joints such as diseases of the hip, iliopsoas, hamstring, sacred iliac or nerves, or by urogenital diseases.

Chronic painful conditions of the hip

Abstract Hip pain is a common complaint with many causes. Pathology in the hip can present with pain referred to sites other than the hip and pain in the hip may result from pathology elsewhere. An accurate history and examination is paramount. Chronic painful conditions of the hip summarised in this paper can be classified into three main groups: intra-articular, extra-articular and hip mimickers. The intra-articular conditions include osteoarthritis, rheumatoid arthritis, femoroacetabular impingement, labral tears and snapping hip secondary to loose bodies, synovial chondromatosis or labral tears. Extra-articular conditions include snapping hip, iliopsoas bursitis, piriformis syndrome and greater trochanteric pain syndrome. Hip mimickers include myofascial pain syndrome, osteitis pubis, sacroiliac joint pain and nerve entrapment syndromes.

Athletic Osteitis Pubis

Athletic osteitis pubis is a painful and chronic condition affecting the pubic symphysis and/or parasymphyseal bone that develops after athletic activity. Athletes with osteitis pubis commonly present with anterior and medial groin pain and, in some cases, may have pain centred directly over the pubic symphysis. Pain may also be felt in the adductor region, lower abdominal muscles, perineal region, inguinal region or scrotum. The pain is usually aggravated by running, cutting, hip adduction and flexion against resistance, and loading of the rectus abdominis. The pain can progress such that athletes are unable to sustain athletic activity at high levels. It is postulated that osteitis pubis is an overuse injury caused by biomechanical overloading of the pubic symphysis and adjacent parasymphyseal bone with subsequent bony stress reaction. The differential diagnosis for osteitis pubis is extensive and includes many other syndromes resulting in groin pain. Imaging, particularly in the form of MRI, may be helpful in making the diagnosis. Treatment is variable, but typically begins with conservative measures and may include injections and/or surgical procedures. Prolotherapy injections of dextrose, anti-inflammatory corticosteroids and a variety of surgical procedures have been reported in the literature with varying efficacies. Future studies of athletic osteitis pubis should attempt to define specific and reliable criteria to make the diagnosis of athletic osteitis pubis, empirically define standards of care and reduce the variability of proposed treatment regimens.

Individualized multi-modal management of osteitis pubis in an Australian Rules footballer

Objective The purpose of this case report is to describe and discuss the successful management of osteitis pubis in a semi-elite Australian Rules football player through the utilization of an individualized multi-modal treatment approach provided by a chiropractor. Clinical Features A 20-year-old male semi-elite Australian Rules football player presented to a chiropractic clinic with groin pain of eight months duration. A clinical diagnosis of osteitis pubis was made through synthesis of the patient history and physical examination. Intervention and Outcome Treatment consisted of high velocity low amplitude spinal manipulative therapy, mechanically assisted adjusting techniques utilizing a hand-held mechanical thrusting instrument and drop piece table, myofascial release and active release soft tissue techniques, proprioceptive neuromuscular facilitation stretching, and an individually designed rehabilitation program. Resolution of signs and symptoms occurred over four weeks. No recurrence of injury was reported over a six-month period. Conclusions This case suggests that the implementation of an individualized multi-modal management approach directed specifically toward an athlete's deficiencies and requirements, may lead to a more rapid recovery from osteitis pubis.

Physical Therapy Management of an Older Individual Following Symphysis Resection Due to Osteitis Pubis

Physical Therapy Management of an Older Individual Following Symphysis Resection Due to Osteitis Pubis

Sports hernia—What is it and what can be done?

Sports hernia is a component of a more severe injury known as footballer's groin or groin disruption injury which consists of: sports (occult) hernia; conjoint tendon tear; adductor tendinopathy; obturator nerve entrapment; osteitis pubis. A sports hernia occurs through torn muscle fibres of the Internal oblique and Transversus abdominis medial to the inferior epigastric vessels in Hesselbach's triangle of the inguinal (groin) canal of the lower abdomen. The presenting symptom is groin pain, discomfort, ache or lower abdominal pain without a visible or palpable hernia.

Femoroacetabular Impingement in the Athlete: Compensatory Injury Patterns

Femoroacetabular impingement is an increasingly recognized cause of hip and groin pain in the athlete. Loss of hip motion from femoroacetabular impingement may result in compensatory injury patterns involving the hemipelvis, including osteitis pubis, sports hernia, sacroiliac joint pain, muscle strains, low back pain, and posterior hip subluxations. Failure to recognize and address intra-articular hip pathology, in addition to treating compensatory injury patterns, can result in continued disability in a subset of athletes.

Developing a dynamic elastomeric fabric orthosis to aid return to sport after lumbopelvic injury

Lumbopelvic pain (LPP) often results from trauma or overuse that can lead to conditions including adductor tears, sacroiliac joint dysfunction and osteitis pubis. Such injuries are often refractory to treatment and can limit the return to competitive sport. Previous research shows that selective compressive forces applied transversely to the pelvis can result in improved lumbopelvic stability and reduced pain, and, compression shorts may aid in preventing athletic lumbopelvic injury. This study applies transverse and diagonal compressive forces to the pelvis in athletes with LPP, and investigates the effects on pain and function. Participants with athletic LPP were screened using five clinical tests. They were included if at least two tests provoked pain. Transverse and diagonal circumferential forces were applied via a belt. Four belt arrays (anterior superior iliac spines (ASIS), right-left across the pelvis, left-right across the pelvis and in combination) and a "no-belt condition" were assessed with the order of presentation randomised. A force of 50 N was applied (determined using a load cell lying in series with the belt). The effect of the belt array on rest pain, pain associated with an active straight leg raise (ASLR) and a 1-m broad jump was assessed using a numerical rating scale. During resisted bilateral hip adduction the onset of pain was indicated using a hand held switch; the maximal force of adduction determined via a load cell. Data were analysed using paired t tests. Preliminary data on 12 participants (9 females, mean 37±10 years) indicate that different belt arrays can alleviate pain both at rest and during active tasks. Pain during ASLR (ipsilateral to the pain) improved with combined belts compared to an ASIS belt (p=0.025). Preliminary results suggest the direction and angle of force application relative to the laterality of pain is important in determining the degree and pattern of pain relief. A larger sample is needed to confirm this (required sample of 31 based on effect size of 0.51 and 80% power). Results will inform the design of a dynamic elastomeric fabric orthosis whose effect on athletic LPP and function will be assessed.

Pelvic MRI findings of juvenile-onset ankylosing spondylitis

Ankylosing spondylitis (AS) is the most common clinical subgroup of sero-negative spondyloarthropathies. Radiographic and clinical signs of bilateral inflammatory involvement of sacroiliac joints are the gold standard for the diagnosis of juvenile AS. Although radiographic evidence of sacroiliitis is included in the definition, it is not mandatory for the diagnosis of juvenile AS. The aim of this study is to describe pelvic enthesitis-osteitis MRI findings accompanying sacroiliitis in a group of juvenile AS. Eleven patients suffering from low back pain underwent MRI of the pelvis and were enrolled in this retrospective study. The mean duration of symptoms was 12 months. The mean age of the 11 cases in our study was 12.18 years (range, 6-19). There were eight boys and three girls. Anteroposterior radiographs of the pelvis were obtained in all patients. Sacroiliac joint involvement was detected in all of the cases by pelvic MRI. Pathologic signal changes were detected in the pubic symphisis (osteitis pubis) in ten cases, trochanteric bursitis in six cases, coxofemoral joint in five cases, crista iliaca in three cases, and ischion pubis in three cases. There was increased T2 signal intensity in eight of the 11 cases (72.7%) relevant with soft tissue edema/inflammation. This high correlation between sacroiliitis and enthesitis suggests that enthesitis could be an important finding in juvenile AS.

Groin Pain in Athletes

Groin pain in athletes is a common problem in sport medicine, and remains a diagnostic challenge. It is more common with sports that involve kicking, rapid accelerations and decelerations, and sudden direction changes. There is an extensive differential diagnosis and overlap in signs between possible diagnoses. It is important to appreciate the anatomy of the groin and undertake a careful history and examination. Adductor strain, groin disruption and osteitis pubis are among the common causes. The aim of this article is to briefly review the most common causes of groin pain in athletes. The diagnosis and management of these conditions are briefly discussed.

Hip Injury - Football

HISTORY - A 21 year old college football player presents with increasing lower abdominal, right groin, and scrotal pain for 1 ½ years duration. He notes no initial trauma or sentinel event for the pain. Over the course of the next several months, the pain steadily increases and became more localized to his right hip/groin area. Patient noticed that the pain was exacerbated by running and sexual activity and radiated all over his pelvis and lower abdomen. PHYSICAL EXAMINATION: Examination revealed a soft, non-tender and non-distended abdomen without visible hernias, palpable masses, or hepatosplenomegaly. The musculoskeletal exam revealed no asymmetry and full flexion and extension of hips. However, decreased adduction and external rotation of the right hip with a negative Patricks test noted. Pt also had pain to palpation over pubic symphysis. Genital exam revealed normal genitalia, without hernia, testicular mass, lesion, or discharge. DIFFERENTIAL DIAGNOSIS Sports Hernia Varicocele/Hydrocele of Testis Sexually Transmitted Infection with Prostatitis/Epididymitis Labral tear of the hip Osteitis Pubis TEST AND RESULTS -U/S of groin/testes - revealed no visible hernias, nephrolithiasis, testicular or appendiceal torsion, varicocele, hydrocele, or mass of testis; however did show right spermatic cord swelling. -MRI Pelvis with and without contrast - 22mm right paralabral cyst and right superior labral tear. No hernia noted. -STI testing performed for Gonorrhea, Chlamydia, Syphilis, HIV, and Hepatitis panel negative on two separate occasions spaced out by 8 months in duration. FINAL/WORKING DIAGNOSIS - Right Labral cyst and Right acetabular labral tear. - Spermatic Cord Swelling. TREATMENT AND OUTCOMES -A series of steroid injections into the right hip using CT guidance to bridge to future hip arthroscopy for labral tear/cyst removal after football season has been completed. -Continue to be followed by athletic trainer for muscle strengthening exercises and stretches. -Scrotal support for spermatic cord swelling. -Returned to full workout routine and collegiate football within 4 weeks of steroid injection, muscle strengthening and stretching with full, painless range of motion, and able to meet the demands of his sport.

A Minimally Disruptive Surgical Technique for the Treatment of Osteitis Pubis in Athletes

Background:Multiple surgical procedures exist for the treatment of osteitis pubis: curettage of the symphysis joint, wedge resection, complete resection of the joint, placement of extraperitoneal retropubic synthetic mesh, and arthrodesis of the joint. However, a paucity of literature has reported long-term successful outcomes with the aforementioned approaches. Patients treated operatively have reported recalcitrant pain resulting from iatrogenic instability. The article presents the results of a conservative operative technique that avoids disruption of adjacent ligaments.Hypothesis:Preserving the adjacent ligamentous structures will allow competitive athletes to return to competition and activities of daily living free of iatrogenic pelvic instability and pain.Study Design:Case series.Methods:Four competitive athletes (2 professional and 2 collegiate football players) diagnosed with osteitis pubis were treated conservatively for a minimum of 6 months. Patients underwent surgical intervention upon failure to respond to nonoperative management. The degenerative tissue was resected, allowing only bleeding cancellous bone to remain while preserving the adjacent ligaments. An arthroscope was used to assist in curettage, allowing the debridement to be performed through a small incision in the anterior capsule.Results:The symptoms of all 4 patients resolved, and they returned to competitive athletics. This ligament-sparing technique provided a solid, stable repair and pain relief.Conclusion:This surgical technique preserves the adjacent ligamentous structures and allows competitive athletes to return to competition and activities of daily living free of pain and void of pelvic instability.Clinical Relevance:This technique is a surgical treatment option for athletes with osteitis pubis who fail conservative treatment.

Osteitis pubis ameliorated after tooth extraction: a case report

Osteitis pubis is a non-infective inflammation of the symphysis pubis, which is known to be associated with trauma, athletic exertion, urological or gynecological surgery, or with rheumatic conditions such as seronegative spondyloarthropathies. In this report, we describe a case of osteitis pubis whose symptoms were completely ameliorated following tooth extraction attributable to periodontitis. A 57-year-old female patient developed osteitis pubis, presenting with pain in the groin area with an elevated Creactive protein (CRP; 4.4 mg/dl) and radiological erosive changes in symphysis pubis. Prednisolone (5 mg/day) and etodolac were prescribed, but the patient's symptoms improved only partially and remained persistent. One year from the patient's first visit, three teeth were extracted due to severe chronic periodontitis, which she had been suffering from for years. Soon after the above tooth extraction, her symptoms appeared completely resolved, and the patient's CRP was decreased to nearly normal levels in 4 weeks. Human leukocyte antigen (HLA)-typing analysis revealed a positive result for HLA-A11, A24, and B54. Because HLA-B54 cross-reacts with HLA-B27, the patient's osteitis pubis was considered to be a form of reactive arthritis associated with periodontitis.

Putrid infectious pubic osteitis: case report and review of the literature on the differential diagnosis and treatment of infectious pubic osteitis and inflammatory pubic osteitis.

The differential diagnosis of osteolytic, destructive, and inflammatory processes around the symphysis, the os pubis, and the ramus ossis pubis includes infectious osteitis pubis, inflammatory osteitis pubis, posttraumatic benign pubic osteolyses in elderly women, and malignant neoplasia. Accurate diagnosis can be a challenge and requires a methodical approach and the use of a variety of diagnostic measures. A case study of an 83-year-old female suffering from infectious pubis osteitis sheds light on the differential diagnosis of these conditions, particularly the distinction between infectious pubic osteitis and inflammatory pubis osteitis. In addition to the diagnostic indicators and methodologies, differential treatments are considered and a review of current literature on the topic is presented.

Endoscopic Pubic Symphysectomy for Reclacitrant Osteitis Pubis Associated With Bilateral Femoroacetabular Impingement

This is the first reported case of the completely endoscopic management of osteitis pubis with pubic symphysectomy. A 31-year-old woman suffered from recalcitrant osteitis pubis that had progressed to an end-stage auto-fused condition. Ossified pubic symphyseal fibrocartilage and adjacent heterotopic bone were endoscopically removed as part of a comprehensive surgery that also involved bilateral arthroscopic surgery for symptomatic femoroacetabular impingement. An innovative dual-portal (anterior and supra-pubic) endoscopic technique is presented along with the rationale for the preservation of the inferior (arcuate) pubic ligament and the posterior pubic ligament. Twelve months following this single-stage surgery, the patient reported high satisfaction with decreased pain, improved function, and resolution of a classic waddling gait. The association of intra-articular hip pathology with osteitis pubis is noted. We believe that this minimally invasive bone-conserving surgery may be useful in the management of recalcitrant osteitis pubis and perhaps find broader application in the outpatient endoscopic treatment of athletes afflicted with this condition.