Symphysis pubis dysfunction (SPD)

• Diastasis pubic symphysis
• Pelvic girdle pain (PGP)

• 665.6 Obstetrical damage to pelvic joints and ligaments
• 848.5 Sprain of pelvis
• 719.45 Pain in joint, pelvic region and thigh

• 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

• Pattern 4B: Impaired posture
• Pattern 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction
• Pattern 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation
• Pattern 4G: Impaired joint mobility, muscle performance, and range of motion associated with fracture

Description

• 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

Essentials of Diagnosis

• Usually associated with excessive movement of the pubic symphysis
• Difficulty with hip adduction and hip abduction
• Waddling gait
• MRI, x-ray, ultrasound

General Considerations

• 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

Demographics

• 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

Signs and Symptoms

• 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

Functional Implications

• Pubic pain with single leg stance
• Difficulty sitting, side lying
• Ability to walk and perform work and daily activities impacted
• Painful sexual intercourse

Possible Contributing Causes

• Stretch or rupture of pubic symphysis ligaments
• Vaginal delivery
  • Forceps delivery
  • Fetal shoulder dystocia; McRoberts maneuver during vaginal delivery5
• Postpartum
• Maternal hip dysplasia
...