Osteitis Pubis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 3: | Line 3: | ||
== Introduction == | == Introduction == | ||
Osteitis pubis is a painful and chronic condition which is common in athletes affecting symphysis | Osteitis pubis is a painful and chronic condition which is common in athletes affecting the pubic symphysis and parasymphyseal bone and it occurs after athletic activity.<ref name=":1">Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO. [https://link.springer.com/article/10.2165/11586820-000000000-00000 Athletic osteitis pubis]. Sports medicine. 2011 May 1;41(5):361-76.</ref> It is actually an overuse condition caused by abnormal muscle forces acting on the pubic symphysis .<ref>Johnson R. [https://link.springer.com/article/10.1007%2Fs11932-003-0020-7 Osteitis pubis]. Current sports medicine reports. 2003 Mar 1;2(2):98-102.</ref> It causes pelvic pain and local tenderness over pubic symphysis. It commonly occurs in athletes who participate in sports involving kicking, twisting , pivoting,cutting and during abrupt directional changes.Osteitis pubis has been described in soccer, rugby, ice hockey,distance running players.<ref name=":0">Via AG, Frizziero A, Finotti P, Oliva F, Randelli F, Maffulli N. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307487/ Management of osteitis pubis in athletes: rehabilitation and return to training–a review of the most recent literature.] Open Access Journal of Sports Medicine. 2019;10:1.</ref> | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
Pubic symphysis is found anteriorly between adjacent pubic bounds covered in hyaline cartilage.It is stabilized by superior pubic ligament and inferior pubic ligament.[Gray's anatomy]<br> | |||
== Mechanism of Injury | == Mechanism of Injury == | ||
Centre of gravity of the body is located within pelvis that’s why it is greatly stressed in all athletic activities. The biomechanical forces are applied through the pelvis of an athlete during kicking, acceleration and deceleration which increases the incidence of osteitis pubis. These forces causes chronic overloading of pubic symphysis and parasymphyseal bone leading to bony stress reaction.<ref name=":2">Beatty T. [https://journals.lww.com/acsm-csmr/fulltext/2012/03000/osteitis_pubis_in_athletes.13.aspx Osteitis pubis in athletes. Current sports medicine reports.] 2012 Mar 1;11(2):96-8.</ref> | |||
== Clinical Presentation = | == Clinical Presentation == | ||
Athlete with osteitis pubis presents with anterior and medial groin pain or it may be located directly over pubic symphysis. Pain may also occur in the lower abdominal muscles, adductor region, perineal region, inguinal and scrotum which is aggravated by running, cutting, hip adduction,flexion against resistance and by activities that causes loading on rectus abdominis. <ref name=":1" /> | |||
== Diagnosis == | |||
On palpation tenderness is common over symphyseal region. Several tests are performed such as pubic symphysis gap test with isometric adductor contraction and lateral compression test. Some provocation tests are helpful i.e single adductor, squeeze and bilateral adductor tests(best) for the assessment of chronic groin pain. Clinical findings can also include Positive FABER test , restricted range of hip motion, sacroiliac loint dysfunction and weakness of abductor or adductor muscles. Along with that radiographs, MRI, triple-phase scintigraphy confirms the diagnosis and exclude any other cause of groin pain.<ref name=":0" /> | |||
== | == Differential Diagnosis == | ||
• direct inguinal hernia, | |||
• sports hernia | |||
• athletic pubalgia, | |||
• indirect inguinal hernia, | |||
• adductor or iliopsoas injury, | |||
• Femoro- acetabular impingement | |||
• acetabular labral tear, | |||
• pelvic stress fracture, | |||
• femoral neck stress fracture, | |||
• lumbar spine referred pain, | |||
• ilioinguinal neuralgia, | |||
• Osteomyelitis can be considered but less common cause in athletes.<ref name=":2" /> | |||
== Epidemiology == | |||
== Management / Interventions == | |||
== References == | == References == | ||
<references />. | <references />. | ||
Revision as of 05:27, 21 September 2020
Original Editor - Tehseen Zahra
Introduction[edit | edit source]
Osteitis pubis is a painful and chronic condition which is common in athletes affecting the pubic symphysis and parasymphyseal bone and it occurs after athletic activity.[1] It is actually an overuse condition caused by abnormal muscle forces acting on the pubic symphysis .[2] It causes pelvic pain and local tenderness over pubic symphysis. It commonly occurs in athletes who participate in sports involving kicking, twisting , pivoting,cutting and during abrupt directional changes.Osteitis pubis has been described in soccer, rugby, ice hockey,distance running players.[3]
Clinically Relevant Anatomy[edit | edit source]
Pubic symphysis is found anteriorly between adjacent pubic bounds covered in hyaline cartilage.It is stabilized by superior pubic ligament and inferior pubic ligament.[Gray's anatomy]
Mechanism of Injury[edit | edit source]
Centre of gravity of the body is located within pelvis that’s why it is greatly stressed in all athletic activities. The biomechanical forces are applied through the pelvis of an athlete during kicking, acceleration and deceleration which increases the incidence of osteitis pubis. These forces causes chronic overloading of pubic symphysis and parasymphyseal bone leading to bony stress reaction.[4]
Clinical Presentation[edit | edit source]
Athlete with osteitis pubis presents with anterior and medial groin pain or it may be located directly over pubic symphysis. Pain may also occur in the lower abdominal muscles, adductor region, perineal region, inguinal and scrotum which is aggravated by running, cutting, hip adduction,flexion against resistance and by activities that causes loading on rectus abdominis. [1]
Diagnosis[edit | edit source]
On palpation tenderness is common over symphyseal region. Several tests are performed such as pubic symphysis gap test with isometric adductor contraction and lateral compression test. Some provocation tests are helpful i.e single adductor, squeeze and bilateral adductor tests(best) for the assessment of chronic groin pain. Clinical findings can also include Positive FABER test , restricted range of hip motion, sacroiliac loint dysfunction and weakness of abductor or adductor muscles. Along with that radiographs, MRI, triple-phase scintigraphy confirms the diagnosis and exclude any other cause of groin pain.[3]
Differential Diagnosis[edit | edit source]
• direct inguinal hernia,
• sports hernia
• athletic pubalgia,
• indirect inguinal hernia,
• adductor or iliopsoas injury,
• Femoro- acetabular impingement
• acetabular labral tear,
• pelvic stress fracture,
• femoral neck stress fracture,
• lumbar spine referred pain,
• ilioinguinal neuralgia,
• Osteomyelitis can be considered but less common cause in athletes.[4]
Epidemiology[edit | edit source]
Management / Interventions[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO. Athletic osteitis pubis. Sports medicine. 2011 May 1;41(5):361-76.
- ↑ Johnson R. Osteitis pubis. Current sports medicine reports. 2003 Mar 1;2(2):98-102.
- ↑ 3.0 3.1 Via AG, Frizziero A, Finotti P, Oliva F, Randelli F, Maffulli N. Management of osteitis pubis in athletes: rehabilitation and return to training–a review of the most recent literature. Open Access Journal of Sports Medicine. 2019;10:1.
- ↑ 4.0 4.1 Beatty T. Osteitis pubis in athletes. Current sports medicine reports. 2012 Mar 1;11(2):96-8.
.
