Osteitis pubis
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| Classification and external resources | |
| DiseasesDB | 33068 |
| eMedicine | pmr/92 sports/90 |
Osteitis pubis is a noninfectious inflammation of the pubis symphysis (also known as the pubic symphysis, symphysis pubis, or symphysis pubica), causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery, and it remains a well-known complication of invasive procedures about the pelvis. It may also occur as an inflammatory process in athletes. The incidence and cause of osteitis pubis as an inflammatory process versus an infectious process continues to fuel debate among physicians when confronted by a patient who presents complaining of abdominal pain or pelvic pain and overlapping symptoms. It was first described in 1924.
The symptoms of osteitis pubis can include loss of flexibility in the groin region, dull aching pain in the groin, or in more severe cases, a sharp stabbing pain when running, kicking, changing directions, or even during routine activities such as standing up or getting out of a car. Tenderness on palpation is also commonly present in the adductor longus origin.
In the pre-antibiotic era, osteitis pubis was an occasional complication of pelvic surgery, and in particular, of retropubic prostatectomy.
Osteitis pubis may be diagnosed with an X-ray, where irregularity and widening of the pubic symphysis are hallmark findings. Similar change is also demonstrated with Computed Tomography (CT), but the multi-planar nature of CT has a higher sensitivity than conventional radiography. Though not well visualised on ultrasound (US), thickening of the superior joint capsule with cyst formation is a clue to the diagnosis, as well as secondary changes (i.e. tendinosis) of the adjacent adductor muscles - particularly the adductor longus and rectus abdominis. US is also useful for excluding a hernia, which may co-exist with osteitis pubis and warrant additional treatment.
Both US and CT may be used for injecting the pubic symphysis with corticosteroid as part of an athlete's treatment program.Magnetic resonance imaging combines the diagnostic advantages of CT and ultrasound, also shows bone marrow edema, and has the advantages of not being operator dependent (unlike US), nor using radiation (such as CT and X-rays). As such, MRI is the modality of choice for evaluation, diagnosis, and treatment planning.
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