Pubalgia-osteitis pubis

• Pubalgia
• Athletic pubalgia
• Pelvic sprain
• Osteitis pubis

• 848.5 Sprain of pelvic

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

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

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.

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 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.

General Considerations

• 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.

Demographics

• Common in participants in exertional sports or distance running

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• Limited hip ROM
• Increased tone or shortening of iliopsoas, rectus abdominus, ...