Bone Health

Radiology Picture of the Day
Osteitis pubis is characterised by non-infectious inflammation of the pubic symphysis. The commonest causes are pregnancy/childbirth, high-level athletic activity, urological or gynaecological surgery, trauma and psoriatic arthritis, though the aetiology is sometimes unknown. The x-ray findings are subchondral erosive change, joint irregularity and sclerosis, which may eventually lead to ankylosis. The main differential diagnoses are infection and hyperparathyroidism, the latter due to bone resorption.

Osteitis pubis, considered to be the most common inflammatory disease of the pubic symphysis, is a self-limiting inflammation secondary to trauma, pelvic surgery, childbirth, or overuse, and it can be found in almost any patient population. Occurring more commonly in men during their 30s and 40s, osteitis pubis causes pain in the pubic area, one or both groins, and in the lower rectus abdominis muscle. The pain can be exacerbated by exercise or specific movements, such as running, kicking, or pivoting on one leg, and is relieved with rest. Pain can occur with walking and can be in one or several of many distributions: perineal, testicular, suprapubic, inguinal, and postejaculatory in the scrotum and perineum. Symptoms are described as "groin burning," with discomfort while climbing stairs, coughing, or sneezing. A greater understanding and awareness of osteitis pubis will reduce patient and physician frustration while improving overall outcomes.
Scott K. Andrews, MD, Peter J. Carek, MD, MS J Am Board Fam Pract 11(4):291-295, 1998

Since 1924, osteitis pubis has been known as a noninfectious inflammation of the pubis symphysis causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery and remains a well-known complication of invasive procedures about the pelvis. However, it may occur as an inflammatory process in athletes. The incidence and etiology of osteitis pubis as an inflammatory process versus an infectious process continues to fuel debate among physicians when confronted by a patient who presents complaining of "abdominal pain" or "pelvic pain" and overlapping symptoms.
Synonyms and related keywords: osteitis pubis, pubis symphysis separation, symphyseal separation, pubis diathesis, gracilis syndrome
Allen & Fried 2007

Family Practice Notebook
Aka: Pubic Symphysis Disruption, Symphysis Pubis Disruption, Symphysis Pubis Separation, Symphysis Pubis Subluxation
Common cause of chronic Groin Pain in athletes
Causes -
Pregnancy
Sports Injury
1. Long distance Running
2. Soccer

Osteitis pubis simulating a soft-tissue lesion P. Malakzadeh-Shirvani, E. Wikholm, A. Assaf Can J Surg, Vol. 50, No. 6, December 2007
steitis pubis is a self-limited, painful inflammatory condition, involving the pubic bones, joint and attached ten- dons. It has been described after trauma, pelvic surgery, childbirth and athletic overuse as well as in some rheumatic conditions.1 We describe a case resulting from trauma.

Surgery for osteitis pubis Ramin Mehin, MD; Robert Meek, MD; Peter O'Brien, MD; Piotr Blachut, MD Can J Surg 2006;49(3):170-6 Background: Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known. Methods: To determine the success of surgical intervention for osteitis pubis, we used a computerized data registry to identify patients (10 women [mean age 40 yr]) who underwent surgery for osteitis pubis. A retrospective chart review was carried out. We also searched the literature for all cases of osteitis pubis managed surgically and identified 73 cases. Results: The 10 patients in our series had had symptoms for a mean of 4 years preoperatively. Onset of pain was insidious in 4 patients, it followed childbirth in 4 and it followed trauma in 2. Depending on the surgeon's preference, either a wedge resection of the symphysis pubis was performed or a symphysiodesis. At the latest follow-up (average 26 mo), although all patients had some improvement, only 6 of 10 patients were satisfied with the outcome. From the literature review, we identified 3 categories of patients with osteitis pubis: elite athletes, patients with postoperative or infectious osteitis pubis and the remainder, which would include the patients in our series. Conclusions: Four types of surgical intervention are described: curettage, arthrodesis, wedge resection and wide resection. The elite athletes respond well to curettage. Patients with osteitis pubis following urologic or gynecologic procedures or have a proven infection require surgery in roughly 50% of cases. The third group has an unpredictable outcome.