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CONDITION/DISORDER SYNONYMS

  • Pubalgia

  • Athletic pubalgia

  • Pelvic sprain

  • Osteitis pubis

ICD-9-CM CODE1

  • 848.5 Sprain of pelvic

ICD-10-CM CODE2

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

PREFERRED PRACTICE PATTERN3

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

PATIENT PRESENTATION

A 23-year-old woman presents with pain in her lower abdomen and groin that has been present for the past week. She reports initiation of kickboxing classes 2 months ago. She notes pain increases with participation in the classes and some relief with rest. She has difficulty rising from deep squat positions and rising from a chair when there is pain and weakness. She has also noted an inability to perform sit-ups when the pain is present. The patient has tenderness to palpation of the pubic tubercles bilaterally, and adductor insertions on the superior pubic rami. She has negative tenderness to McBurney point, and no palpable masses in the lower abdomen or along the inguinal ligament bilaterally.

KEY FEATURES

Description

  • 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.

FIGURE 137-1

Hernia sites. (From DeCherney AH, Nathan L, Murphy Goodwin T, Laufer N, Roman AS. Current Diagnosis & Treatment: Obstetrics & Gynecology. 11th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Essentials of Diagnosis

  • 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 abdominis precipitate symptoms.

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

  • Palpation of pubic tubercles, inferior pubic rami, rectus abdominis 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.

General Considerations

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

  • Caused by repeated trauma ...

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