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  • Diastasis pubic symphysis
  • Pelvic girdle pain (PGP)

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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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  • 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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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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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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Possible Contributing Causes

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  • Stretch or rupture of pubic symphysis ligaments
  • Vaginal delivery
    • Forceps delivery
    • Fetal shoulder dystocia; McRoberts maneuver during vaginal delivery5
  • Postpartum
  • Maternal hip dysplasia
  • Direct trauma from fracture, fall, childbirth
  • Athletic ...

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