Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Osteitis Pubis

Some athletes are afflicted by pain located in the anterior aspect of the pubic bone. Inflammation of the pubic bone occurs in soccer, ice hockey and American football players, as well as in long-distance runners and weightlifters. There is usually no trauma involved, instead there is a gradual onset with pain centrally localized in the groin, often radiating either up to the abdomen or down to the medial aspects of the thighs. The precise cause of this injury is unclear, but muscle strain or stress fractures have been suggested. Pubic instability secondary to adductor imbalance, trauma or overuse may contribute to osteitis pubis. Ruling out disease of the bladder or prostate gland is important.

Symptoms and diagnosis

– Gradual onset of pain, centrally localized in the groin with radiation to the sides and distally, is typical.
– Tenderness is felt over the symphysis pubis.
– Passive abduction (away from the body) and active adduction (toward the body) and internal rotation of the hip are painful.
– Pain may often be more intense the morning after a training event, or when changing position in bed at night.
– A bone scan may show an increased uptake early in the course of the disorder.
– Typical radiographic findings may be present after 2–3 weeks, such as erosion or sclerosis (hardened bone) of the symphyseal junction.
– MRI and CT scans can give valuable information.
It should be pointed out that X-ray changes resembling those of osteitis pubis can sometimes be incidental findings, causing the athlete no problems whatsoever.

Treatment

The condition is self-limiting, and the athlete should be informed of this. The problem is that the condition is sometimes long-lasting and difficult to manage.
– Pain-causing situations should be avoided.
– Anti-inflammatory treatment and physical therapy may help.
– Heat retaining pants may help.
– A steroid injection may be given under fluoroscopic control.
– Surgery is rarely indicated; in extremely resistant cases with instability it may be tried, but results are debatable.
– Return to sport is on average possible after 9 months of conservative treatment. Occasionally symptoms may last more than 2 years.

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