Osteitis pubis
A painful inflammatory process involving the pubic symphysis and its surrounding structures including the pubic rami, cartilage, musculotendinous and ligamentous structures of the pelvis. Predisposing factors that contribute to the development of this condition include, urological and gynecological procedures, pregnancy, trauma, degenerative/rheumatological states, and the athletic participation. This condition may be confused with osteomyelitis pubis but the defining feature is an inflammatory response that is not accompanied with pyrexia.
Signs and symptoms
- Pain with walking located in the suprapubic/inguinal area
- Insidious onset of adductor pain and abdominal discomfort
- Aggravating athletic activities (sprinting, kicking, cutting and twisting)
- Pain with resisted strength testing of adductor
- Pain with resisted strength testing of lower abdominal group
- Tenderness to palpation of the pubic symphysis
- Decreased unilateral hip ROM
- Positive cross leg test
- Palpable mass over pubic symphysis
- Audible click over pubic symphysis during daily activities
physical therapy implications
- Education on activity modification to reduce provocative movements
- Soft tissue mobilizations to dysfunctional/overuse muscles
- Strengthening of antagonistic muscle groups to create balanced forces
- Referral to physician for multidisciplinary intervention (corticosteroid injection into pubic symphysis)
Osteomyelitis (pubis)
Similar clinical presentation of osteitis pubis, except it is typically spontaneous and nontraumatic in onset and is accompanied by a fever. Exact mechanism is unknown but it has been postulated that microtrauma of the pubic symphysis in athletic activities predispose the pubis to bacterial seeding leading to a bacterial infection. Osteomyelitis pubis should be suspected in patients with acute onset of pubic symphysis pain, fever and systematic involvement. This condition may be confused with osteitis pubis but the defining feature is an infectious process that is accompanied with pyrexia.
signs and symptoms
- Pain over pubic/suprainguinal area
- Tenderness over pubic symphysis
- Painful hip abduction
- Fever
- Wide-based gait
physical therapy implications
Red flag and immediate referral to Physician. Course of treatment is antibiotics and severe cases, may require debridement of osseous tissue with bone grafting.
References
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. 2011;45(1):57-64. Epub 2008 Sep 2023.
Meyers WC, Yoo E, Devon ON, et al. Understanding "Sports Hernia" (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes. Operative Techniques in Sports Medicine. 2007;14(4):165-177.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.
Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed: Saunders Elsevier, St. Louis, MO; 2007.
Images: http://www.ajronline.org
Images: http://www.sun.ac.za/ortho/webct-ortho/osteitis/osteitis.html
Meyers WC, Yoo E, Devon ON, et al. Understanding "Sports Hernia" (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes. Operative Techniques in Sports Medicine. 2007;14(4):165-177.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.
Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed: Saunders Elsevier, St. Louis, MO; 2007.
Images: http://www.ajronline.org
Images: http://www.sun.ac.za/ortho/webct-ortho/osteitis/osteitis.html