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Osteitis pubis

INTRODUCTION

Osteitis pubis is defined as an idiopathic, inflammatory disease of the pubic symphysis and surrounding structures [1,2]. Osteitis pubis most commonly occurs among athletes but can also occur among non-athletes as a result of any pelvic stress (eg, trauma, pelvic surgery, pregnancy).

This topic will discuss the epidemiology, diagnosis, and management of osteitis pubis. Other sports-related injuries and pelvic osteomyelitis are discussed elsewhere. (See "Sports-related groin pain or 'sports hernia'" and "Classification, clinical features and diagnosis of inguinal and femoral hernias in adults" and "Pelvic osteomyelitis".)

ANATOMY

Osteitis pubis is an inflammatory process involving the pubic symphysis and its surrounding attachments, including cartilage, ligaments, muscles, and the pubic rami (figure 1). The pubic symphysis is mainly composed of fibrocartilage and is a nonsynovial, nonvascular joint. The pubic symphysis is reliant on four ligaments to maintain its supportive integrity. Most of the strength and support arise from the superior and inferior ligaments, whereas the anterior and posterior ligaments are of less supportive importance. The pelvic floor musculature, composed of the levator ani and coccygeus, insert posteriorly at the pubic symphysis. The pectineus, rectus abdominis, and oblique externus muscles, as well as the inguinal ligament, insert near the superior portion of the pubic symphysis. The pubic rami give rise to several muscle origins: adductor magnus, adductor longus, adductor brevis, and gracilis. These muscles make up the adductors of the hip [3].  

EPIDEMIOLOGY

The prevalence of osteitis pubis among the general population of athletes ranges from 0.5 to 6.2 percent [1,4,5]. Although many different sports may be associated with osteitis pubis, sports with a higher risk include soccer, football, ice hockey, and rugby [6,7].

Many factors are known to play a role in developing osteitis pubis. Repetitive movements within the pelvis, such as those associated with athletic activity, predispose to osteitis pubis. The following conditions are also associated with osteitis pubis: rheumatologic diseases (eg, osteoarthritis, reactive arthritis, spondyloarthropathies), pregnancy, pelvic trauma, and pelvic surgery [8].

             

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Literature review current through: Jun 2014. | This topic last updated: Jun 12, 2013.
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References
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  1. Johnson R. Osteitis pubis. Curr Sports Med Rep 2003; 2:98.
  2. Pauli S, Willemsen P, Declerck K, et al. Osteomyelitis pubis versus osteitis pubis: a case presentation and review of the literature. Br J Sports Med 2002; 36:71.
  3. Hölmich P. Adductor-related groin pain in athletes. Sports Med Arthrosc Rev 1997; 5:285.
  4. Batt ME, McShane JM, Dillingham MF. Osteitis pubis in collegiate football players. Med Sci Sports Exerc 1995; 27:629.
  5. Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis Pubis Syndrome in the Professional Soccer Athlete: A Case Report. J Athl Train 2001; 36:437.
  6. Pham DV, Scott KG. Presentation of osteitis and osteomyelitis pubis as acute abdominal pain. Perm J 2007; 11:65.
  7. Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes. Results of corticosteroid injections. Am J Sports Med 1995; 23:601.
  8. Mandelbaum B, Mora S. Osteitis Pubis. Operative Techniques in Sports Medicine 2005; 13:62.
  9. Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med 2008; 36:122.
  10. Wiley JJ. Traumatic osteitis pubis: the gracilis syndrome. Am J Sports Med 1983; 11:360.
  11. Williams JG. Limitation of hip joint movement as a factor in traumatic osteitis pubis. Br J Sports Med 1978; 12:129.
  12. Major NM, Helms CA. Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in athletes. Skeletal Radiol 1997; 26:711.
  13. Meyers WC, Foley DP, Garrett WE, et al. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med 2000; 28:2.
  14. COVENTRY MB, MITCHELL WC. Osteitis pubis: observations based on a study of 45 patients. JAMA 1961; 178:898.
  15. Sexton DJ, Heskestad L, Lambeth WR, et al. Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review. Clin Infect Dis 1993; 17:695.
  16. Koch RA, Jackson DW. Pubic symphysitis in runners. A report of two cases. Am J Sports Med 1981; 9:62.
  17. Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, et al. Athletic pubalgia: definition and surgical treatment. Ann Plast Surg 2005; 55:393.
  18. Knoeller SM, Uhl M, Herget GW. Osteitis or osteomyelitis of the pubis? A diagnostic and therapeutic challenge: report of 9 cases and review of the literature. Acta Orthop Belg 2006; 72:541.
  19. Combs JA. Bacterial osteitis pubis in a weight lifter without invasive trauma. Med Sci Sports Exerc 1998; 30:1561.
  20. Karpos PA, Spindler KP, Pierce MA, Shull HJ Jr. Osteomyelitis of the pubic symphysis in athletes: a case report and literature review. Med Sci Sports Exerc 1995; 27:473.
  21. 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; 45:57.
  22. O'Connell MJ, Powell T, McCaffrey NM, et al. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes. AJR Am J Roentgenol 2002; 179:955.
  23. Williams PR, Thomas DP, Downes EM. Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail. Am J Sports Med 2000; 28:350.
  24. King JB. "Treatment of osteitis pubis in athletes: results of corticosteroid injections". Am J Sports Med 1996; 24:248.
  25. McMurtry CT, Avioli LV. Osteitis pubis in an athlete. Calcif Tissue Int 1986; 38:76.
  26. Vincent C. Osteitis pubis. J Am Board Fam Pract 1993; 6:492.
  27. Mehin R, Meek R, O'Brien P, Blachut P. Surgery for osteitis pubis. Can J Surg 2006; 49:170.
  28. Mulhall KJ, McKenna J, Walsh A, McCormack D. Osteitis pubis in professional soccer players: a report of outcome with symphyseal curettage in cases refractory to conservative management. Clin J Sport Med 2002; 12:179.
  29. Olerud S, Grevsten S. Chronic pubic symphysiolysis. A case report. J Bone Joint Surg Am 1974; 56:799.
  30. Ekstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain: A prospective randomised study in soccer players. Eur J Sports Traumatol 2001; 23:141.
  31. Moore RS Jr, Stover MD, Matta JM. Late posterior instability of the pelvis after resection of the symphysis pubis for the treatment of osteitis pubis. A report of two cases. J Bone Joint Surg Am 1998; 80:1043.