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Osteitis Pubis

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Osteitis Pubis, Pubic Symphysis Disruption, Symphysis Pubis Disruption, Symphysis Pubis Separation, Symphysis Pubis Subluxation, Pubic Symphysis Diastasis

  • See Also
  1. Hip Pain
  • Epidemiology
  1. Common cause of chronic Groin Pain in athletes
  • Causes
  1. Pregnancy
  2. Sports Injury
    1. Long distance Running
    2. Soccer
  • Pathophysiology
  1. Pregnancy
    1. Expanding pressure from growing fetus
  2. Sports-related repetitive stress injuries
    1. Overuse of hip adductors and gracilis Muscle
    2. Shearing forces on Pubic Symphysis
    3. Traction on pelvic musculature
  • Risk Factors
  • Predisposing factors in sports
  1. Limited internal hip rotation
  2. Sacroiliac joint fixation
  3. Lower limb biomechanical abnormalities (postulated)
    1. Leg Length Discrepancy
    2. Over-pronation
    3. Genu Varum (Varus knee deformity)
    4. Genu Valgum (Valgus knee deformity)
  • Symptoms
  1. Groin Pain of gradual onset and progression
  2. Exercise-induced pain
    1. Adductor pain in medial thigh (80%)
    2. Pubic Symphysis pain (40%)
    3. Lower Abdominal Pain (30%)
    4. Hip Pain (12%)
    5. Referred Scrotal Pain (8%)
  • Signs
  1. Differentiate from Adductor related Groin Pain (see Adductor Strain)
  2. Tenderness to palpation of Pubic Symphysis and adjacent pubic bone
  3. Provocative maneuvers
    1. Active adduction (distal symphysis involvement)
    2. Sit-ups (proximal symphysis involvement)
  • Imaging (non-pregnant patients)
  1. XRay (changes are often seen in asymptomatic athletes)
    1. Widened Pubic Symphysis
    2. Irregular articular surface
    3. Periarticular sclerosis
  2. Isotope bone scan
    1. Increased uptake at Pubic Symphysis
    2. Poor Test Sensitivity
  3. Pelvis MRI (preferred study if not responding to conservative therapy)
    1. Early: Bone Marrow edema
    2. Later: Low signal uptake on T1 and T2-weighted images
      1. Pubic Symphysis joint degeneration
  • Differential Diagnosis
  1. See Groin Injuries in Athletes
  2. Adductor Strain
  3. Pubic Apophysitis (children and young adult athletes)
  4. Osteomyelitis of the Pubic Symphysis
    1. Spontaneous onset following surgery near Pelvis
  • Management
  • Athlete
  1. General Measures
    1. Avoid provocative activities
    2. Cross training with pain-free Exercise
  2. Physical Therapy
    1. Hip Range of Motion
    2. Adductor Stretching and strengthening
    3. Pelvic stability
    4. Core Muscle Strength
    5. Correct biomechanical abnormalities
      1. Leg Length Discrepancy
      2. Over-pronation
  3. Specialty referral Indications
    1. No improvement after >12 weeks of physical therapy
  4. Other measures in refractory cases
    1. Local Corticosteroid Injection may be considered in acute cases
    2. Pubic Symphysis curettage
    3. Pubic Symphysis Arthrodesis (symphysiodesis)
  • Prognosis
  1. Complete resolution may require 9-12 months
  • References
  1. Schleihauf (2019) Crit Dec Emerg Med 33(5): 19-28
  2. Maloy (2025) Am Fam Physician 111(4): 337-43 [PubMed]
  3. Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]
  4. Fricker (1991) Sports Med 12:266-79 [PubMed]