- Home
- Centre Locations
- SOS Facilities
- SOS Services
- Contact Us
- Imaging
- Conditions
- The Head and Neck
- The Shoulder and Elbow
- Shoulder Arthritis
- Reverse Geometry Shoulder Replacement
- Frozen Shoulder
- Clavicle Fractures
- Clavicle Fractures - Pin v Plate
- How I Pin a Clavicle (Graphic Scenes)
- Tennis Elbow
- Rotator Cuff Tendonitis
- Acromioclavicular Joint
- Dislocated Shoulder
- Steroid Injections
- Operations and Complications 2006
- How Bad Is My Shoulder?
- Brachial Plexus Block
- The Hand
- The Spine
- The Hip and Groin
- The Knee and Shin
- The Foot and Ankle
- Payment
- Articles
- Education
- Products
- Testimonials
- News
- Careers
- Media Centre
- Links
| Osteitis Pubis |
Osteitis Pubis is a syndrome characterised by pain and bony erosion of the symphysis pubis. This condition may be difficult to distinguish from adductor strains, and the two conditions may occur together in the same patient.
Symptoms
The clinical symptoms of Osteitis Pubis include exercise-induced pain over the pelvic area that can radiate into the inside of the thighs and abdomen. Symptoms are gradual in onset, slowly increasing in severity if activities are not curtailed.
Causes
Osteitis Pubis occurs commonly in distance runners, hurdlers, footballers as well as tennis and ice hockey players. The most likely mechanism is repetitive stress from increased shearing forces on the pubic symphysis or from increased stress placed on the joint from the traction of the pelvic musculature. Other factors such as limitation of internal rotation of the hips or sacroiliac joint dysfunction can also place excessive stresses on the joint. Biomechanical abnormalities of the lower limb (leg length discrepancies, excessive pronation, varus or valgus deformities) could also place the pelvis in the path of excessive force.
Diagnosis
On physical examination, tenderness over the pubic symphysis is usually present, and lack of such tenderness usually excludes the diagnosis. Pain can be provoked by active adduction of the hip if the distal symphysis is involved, or by sit ups if the proximal portion is involved.
Plain radiographs (x-rays) may show widening of the pubic symphysis, irregular contour of articular surfaces or periarticular sclerosis. However, in early or mild disease, radiographic findings may be normal.
MRI scan shows marrow oedema in the pubic bones early in the course of the condition, followed by low signal images as the disease progresses. This is the modality most useful in diagnosing Osteitis Pubis.
Treatment
Treatment begins with reassurance to the patient / athlete that the condition is self-limiting. However, it can take more than one year to completely heal; the average time of healing is approximately 9 months.
Pain producing activity should be avoided. Pounding type cyclic activities such as running should be substituted by non painful activities such as swimming and appropriate stretching and strengthening exercises of the surrounding musculature as directed by a physiotherapist. Core stability exercises are also useful to maximise functional pelvic stability.
The aims of physiotherapy are to identify and address any muscle imbalances and range of movement deficits around the hip. In addition any biomechanical abnormalities that would place undue shear stresses on the pelvis (leg length discrepancies, excessive pronation, etc.) will also be identified and corrected. When the condition settles progressive rehabilitation back to the patient’s previous lifestyle and sport will commence. Corticosteroid injections may have a role in hastening the course of the disease under the discretion of an orthopaedic consultant.
By Sharon Helsby (SOS Centres Senior Physiotherapist/ Specialist Hip Clinician)