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CONDITION/DISORDER SYNONYMS

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  • Pubic symphysis pain

  • Pubic symphysis diastasis

  • Sacroiliac joint pain

  • Sacroiliac joint dysfunction

  • Symphysis pubis dysfunction

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ICD-9-CM CODES

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  • 648.7 Bone and joint disorders of back pelvis and lower limbs of mother complicating pregnancy childbirth or the puerperium

  • 719.45 Pain in joint, pelvic region and thigh

  • 724.6 Disorders of sacrum

  • 846 Sprains and strains of sacroiliac region

  • 846.1 Sprain of sacroiliac ligament

  • 846.8 Sprain of other specified sites of sacroiliac region

  • 846.9 Sprain of unspecified site of sacroiliac region

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ICD-10-CM CODES

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  • CM 026.7 Subluxation of symphysis pubis in pregnancy, childbirth, and the puerperium

  • CM 026.71 Subluxation of the symphysis pubis in pregnancy

  • CM 026.711 Subluxation of the symphysis pubis in pregnancy, first trimester

  • M25.559 Pain in unspecified hip

  • S33.2 Dislocation of sacroiliac and sacrococcygeal joint

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PREFERRED PRACTICE PATTERN

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  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

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PATIENT PRESENTATION

A 31-year-old female currently 23 weeks pregnant in her second pregnancy reports to her obstetrician/gynecologist that she is experiencing increasing pain in her “butt or her hip.” The symptoms have gradually become worse over the past few weeks. She feels sharp pain while rolling in bed, moving from sit to stand position, and when she starts to walk after sitting. She is having difficulty lifting and carrying her 2-year-old.

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KEY FEATURES

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Description
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  • Pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joints (SIJ) and/or the pubic symphysis.1

  • Pain may radiate in the posterior thigh and can also occur in conjunction with/or separately in the symphysis.1

  • Endurance capacity for standing, walking, and sittingis diminished.

  • Generally arises in relation to pregnancy, trauma, orreactive arthritis.

  • Gradual or acute onset secondary to strain and impairment of load transfer at SIJ or symphysis pubis.

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FIGURE 275-1

Palpation and location of the sacroiliac joints. (From Lawry GV. Systematic Musculoskeletal Examinations. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Diagnosis made by clinical examination including provocation tests and load transfer tests

  • Lumbar spine involvement and hip joint involvement must be ruled in or out

  • Reproduction of symptoms with clinical examination

  • No imaging performed on pregnant women unless pain associated with acute trauma such as motor vehicle accident

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FIGURE 275-2

Sacroiliac joint space on x-ray. (From Lawry GV. Systematic Musculoskeletal Examinations. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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FIGURE 275-3

Muscles and fascia of the pelvic walls and pelvic floor innervation. Ischial spine is marked ...

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