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  • Pubalgia
  • Athletic pubalgia
  • Pelvic sprain
  • Osteitis pubis

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  • 848.5 Sprain of pelvic

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

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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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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 floor
  • Pain/limitation with sitting up from supine positions

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Possible Contributing Causes

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  • Limited hip ROM
  • Increased tone or shortening of iliopsoas, rectus abdominus, or hip adductors
  • Participation in exertional sports ...

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