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Condition/Disorder Synonyms

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  • Pubalgia

  • Athletic pubalgia

  • Pelvic sprain

  • Osteitis pubis

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ICD-9-CM Code

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  • 848.5 Sprain of pelvic

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ICD-10-CM Code

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  • S33.8XXA Sprain of other parts of lumbar spine and pelvis, initial encounter

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Preferred Practice Pattern1

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Key Features

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Description

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  • Pubalgia-osteitis pubis is a collective term that refers to disorders causing chronic pubic pain.

  • Pubalgia-osteitis pubis includes osteitis pubis and athletic pubalgia, which are overuse conditions involving stress to the pubic symphysis.

  • All conditions result in abnormal stress to the pubic bone, pubic tubercle, or pubic symphysis.

  • Symptoms due to increased mechanical stress in the pubic region due to abnormalities or stress from osseous, ligamentous, or muscular structures.

  • Symptoms typically reduce with light activity but worsen with exertion.

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Essentials of Diagnosis

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  • Diagnosed primarily through signs and symptoms, and exclusion of other pathologies typical to the region.

  • Clustering of special tests/signs and symptoms is most accurate, as there are no confirmatory special tests.

  • Injury typically due to chronic, repetitive stress to the pubic region during exertional sports

  • Often result of repetitive stress such as kicking, sprinting, or twisting at high speeds during sports

  • Stresses from hip adductor insertion or rectus abdominus precipitate symptoms.

  • Weight-bearing forces with athletic activity result in stress to pubic symphysis.

  • Palpation of pubic tubercles, inferior pubic rami, rectus abdominus and adductor tendons elicit pain.

  • Differential diagnosis from other orthopedic (pubic, spine) or medical (intra-abdominal pathology, hernia) pathologies that may warrant a more immediate surgical or medical intervention is essential.

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General Considerations

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  • Pubalgia-osteitis pubis is collective term and often refers to several possible conditions.

  • Caused by repeated trauma from exertional activities that over-stress the pubic bone or tendons that insert upon it, and shearing of the pubic symphysis

  • Diagnosis often made through exclusion of other pathologies.

  • Full history of symptoms, medical history screening, and differential pelvic/lower abdominal orthopedic and medical screening examination will ensure appropriate diagnosis.

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Demographics

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  • Common in participants in exertional sports or distance running

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Clinical Findings

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Signs and Symptoms

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  • Lower abdominal pain or anterior pelvic pain with exertion, responds to rest

  • Lower abdominal pain or anterior pelvic pain with sit-ups, kicking, running, sprinting, or squats

  • Tenderness over the pubic tubercles

  • Possible tenderness over the proximal insertions of the adductor tendons or insertion of the rectus abdominus.

  • Possible pain and ROM limitation with passive hip flexion or abduction

  • Possible weakness of lower abdominals or any components of hip musculature

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Functional Implications

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  • Pain/limitation with running

  • Pain/limitation with squatting into or rising from chair

  • Pain/limitation with getting up from ...

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