1. Describe the salient findings.
There is prominent fluid within the symphyseal pubic articular cartilage. No marrow alteration is identified in the parasymphyseal bone marrow. No abnormality was identified at the left hip.
2. What is your diagnosis or differential diagnosis?
Diagnosis – Post traumatic osteitis pubis.
Differential diagnosis includes stress fracture, inflammatory spondyloarthropathy, infection, and isolated injury to adductor tendons which originate near the symphysis.
Discussion
These findings is this patient are related to acute trauma. Note however that similar changes at the symphysis pubis may occur in a non-acute presentation. This would include athletes such as football players, hockey players, tennis players. Non-athletes who may develop similar changes include post-partum diastasis.
Synonyms include chronic/athletic osteitis pubis, pelvic instability, groin disruption injury, groin strain, and athletic pubalgia.
Symptoms include acute or chronic pain in the groin and/or lower abdomen which may be poorly localized or may lateralize to one side. The pain may radiate into the thigh or to either or both sacroiliac joints. Activity such as walking, running and other exercises will exacerbate the symptoms. Coughing, sneezing, and straining may increase the pain.
Physical exam will show tenderness to palpation or direct pressure over the symphysis pubis, positive adductor squeeze test, pain on resisted sit up or hip flexion. Other associated findings may include sacroiliac dysfunction, leg length inequality, and, if there is hip pain, restricted internal rotation at the painful hip.
Radiographically there may be sclerosis and subcortical cystic changes at the symphysis pubis, most often in non-acute cases. There may also be evidence of leg length inequality. If MRI is performed, careful assessment for pubic fracture and tear at the rectus abdominis-adductor aponeurosis should be made.
Several treatment options are available. Therapy including ice, bracing, and rest for 1-3 weeks is generally recommended. Patients may also benefit from manipulative therapy for the symphysis pubis, sacroiliac joints, and hips as indicated. The presence of a structural or functional short leg should be addressed. Rehabilitation exercises include core strengthening and appropriate stretching exercises. Athletes may continue to play to pain tolerance. Wearing compression shorts during activity, icing after activity, and analgesic cream or corticosteroid injection may help control pain in athletes who decide to continue their activities. Symptoms may take 3-4 months to resolve, or longer if athletes decide to continue their activities. Tenotomy, a tendon release procedure is an option in rare cases. In cases of development of gross pubic instability surgical arthrodesis may be performed.
There is prominent fluid within the symphyseal pubic articular cartilage. No marrow alteration is identified in the parasymphyseal bone marrow. No abnormality was identified at the left hip.
2. What is your diagnosis or differential diagnosis?
Diagnosis – Post traumatic osteitis pubis.
Differential diagnosis includes stress fracture, inflammatory spondyloarthropathy, infection, and isolated injury to adductor tendons which originate near the symphysis.
Discussion
These findings is this patient are related to acute trauma. Note however that similar changes at the symphysis pubis may occur in a non-acute presentation. This would include athletes such as football players, hockey players, tennis players. Non-athletes who may develop similar changes include post-partum diastasis.
Synonyms include chronic/athletic osteitis pubis, pelvic instability, groin disruption injury, groin strain, and athletic pubalgia.
Symptoms include acute or chronic pain in the groin and/or lower abdomen which may be poorly localized or may lateralize to one side. The pain may radiate into the thigh or to either or both sacroiliac joints. Activity such as walking, running and other exercises will exacerbate the symptoms. Coughing, sneezing, and straining may increase the pain.
Physical exam will show tenderness to palpation or direct pressure over the symphysis pubis, positive adductor squeeze test, pain on resisted sit up or hip flexion. Other associated findings may include sacroiliac dysfunction, leg length inequality, and, if there is hip pain, restricted internal rotation at the painful hip.
Radiographically there may be sclerosis and subcortical cystic changes at the symphysis pubis, most often in non-acute cases. There may also be evidence of leg length inequality. If MRI is performed, careful assessment for pubic fracture and tear at the rectus abdominis-adductor aponeurosis should be made.
Several treatment options are available. Therapy including ice, bracing, and rest for 1-3 weeks is generally recommended. Patients may also benefit from manipulative therapy for the symphysis pubis, sacroiliac joints, and hips as indicated. The presence of a structural or functional short leg should be addressed. Rehabilitation exercises include core strengthening and appropriate stretching exercises. Athletes may continue to play to pain tolerance. Wearing compression shorts during activity, icing after activity, and analgesic cream or corticosteroid injection may help control pain in athletes who decide to continue their activities. Symptoms may take 3-4 months to resolve, or longer if athletes decide to continue their activities. Tenotomy, a tendon release procedure is an option in rare cases. In cases of development of gross pubic instability surgical arthrodesis may be performed.