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277: PUBIC SYMPHYSIS DYSFUNCTION

Cynthia E. Neville, DPT, PT, WCS

CONDITION/DISORDER SYNONYMS

  • Diastasis pubic symphysis

  • Pelvic girdle pain (PGP)

ICD-9-CM CODES

  • 665.6 Damage to pelvic joints and ligaments

  • 719.45 Joint pain—pelvis

  • 848.5 Sprain of pelvis

ICD-10-CM CODES

  • 026.7 Subluxation of symphysis pubis in pregnancy, childbirth, or puerperium

  • 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

  • 071.6 Obstetric damage to pelvic joints and ligaments

PREFERRED PRACTICE PATTERNS1

  • 4B: Impaired Posture

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

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

  • 4G: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Fracture

PATIENT PRESENTATION

A 32-year-old woman who was 24 weeks pregnant was performing Pilates exercises with a trainer using the reformer apparatus. During an exercise, she had one leg kneeling on the reformer and the other leg off of the reformer. She was pushing the leg on the reformer behind her against resistance in a lunge movement. After the exercise session, she started having difficulty walking. She tried to open a heavy door in an office building and had sharp severe pain in her groin. She fell to the ground and could not get up to walk.

FIGURE 277-1

Potential causes of trochanteric, pubic, and thigh pain. (From Dutton D. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 277-2

This AP radiograph in a 20-year-old male following trauma reveals diastasis of the pubic symphysis. (From Malone TR, Hazle C, Grey ML. Imaging in Rehabilitation. http://accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Pubic symphysis pain

  • Pain in the groin

  • Pain in the perineum

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

  • Pain may radiate to the anterior or upper thigh

Essentials of Diagnosis

  • Usually associated with excessive movement of the pubicsymphysis

  • Difficulty with hip adduction and hip abduction

  • Waddling gait

  • MRI, X-ray, ultrasound

General Considerations

  • Pubic symphysis joint capable of undergoing anatomical changes during pregnancy2

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

  • Athletic injuries

  • Rule out injury to hip including labral tear

  • Chronic condition may result in osteitis pubis: Arthritis ...

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