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 and other infections of the bony pelvis".)
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 .
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 .