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Condition/Disorder Synonym

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  • Diastasis pubic symphysis

  • Pelvic girdle pain (PGP)

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ICD-9-CM Codes

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  • 665.6 Obstetrical damage to pelvic joints and ligaments

  • 848.5 Sprain of pelvis

  • 719.45 Pain in joint, pelvic region and thigh

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ICD-10-CM Codes

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  • 071.6 Obstetric damage to pelvic joints and ligaments

  • 026.72 Subluxation of symphysis (pubis) in childbirth

  • O26.71 Sublux of symphysis (pubis) in pregnancy

  • O26.711 Sublux of symphysis (pubis) in pregnancy, first trimester

  • O26.712 Sublux of symphysis (pubis) in pregnancy, second trimester

  • O26.713 Sublux of symphysis (pubis) in pregnancy, third trimester

  • S33.4 Traumatic rupture of symphysis pubis

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Preferred Practice Patterns1

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Key Features

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Description

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  • Pubic symphysis pain

  • Pain in the groin

  • Pain in the perineum

  • Pain often increases with weight bearing, sitting, side lying, transitional movements, and palpation of pubic symphysis

  • Pain may radiate to the anterior or upper thigh

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Essentials of Diagnosis

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  • Usually associated with excessive movement of the pubic symphysis

  • Difficulty with hip adduction and hip abduction

  • Waddling gait

  • MRI, x-ray, ultrasound

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General Considerations

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  • Pubic symphysis joint is capable of undergoing anatomical changes during pregnancy including widening of the interpubic gap, increased mobility, thickening of ligaments, and the appearance of gas in the joint2

  • Consider other pelvic girdle joints including sacroiliac (SI) joint and sacrococcygeal joint involvement

  • Athletic injuries

  • Rule out injury to hip including labral tear

  • Chronic condition may result in osteitis pubis; arthritis of the pubic symphysis joint

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Demographics

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  • May occur during pregnancy, during delivery, or postpartum

  • One woman in 569 deliveries3 sustained a pubic symphysis injury

  • Estimated incidence of pubic symphysis separation during delivery is 1 in 300 to 1 in 30,000 pregnancies

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Clinical Findings

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Signs and Symptoms

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  • Pain in the groin

  • Pain with weight bearing especially on one leg

  • Pain in the sitting position

  • Pain with transition from sitting to standing

  • Pain with standing, walking, forward flexion

  • Pain may radiate to the anterior or upper thigh

  • Increased pain during menstruation

  • Inflammation

  • Poor sitting posture

  • Frequent shifts in sitting position, sitting down carefully

  • Symptoms are more likely if there is more than 10 mm horizontal and 5 mm vertical separation of the pubic bones4

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Functional Implications

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  • Pubic pain with single leg stance

  • Difficulty sitting, side lying

  • Ability to walk and perform work and daily activities impacted

  • Painful sexual intercourse

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