Dr. Kevin Yip

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

Featured on Channel NewsAsia

Symphysitis

SYMPTOMS

There is gradual onset of diffuse or localised exercise-induced pain in both the groin and around the symphysis. The symptoms are often vague and secondary muscular symptoms are very common, misleading the examiner.

AETIOLOGY

This condition is thought to be a stress reaction from excessive jumping or running exercises but the exact aetiology is unknown. It typically presents as a result of sudden changes in training habits, such as an increase in intensity or amount of impact.

CLINICAL FINDINGS

There is tenderness on palpation over the symphysis. However, this area is often tender in normal athletes, in particular footballers and other contact sport athletes. Pain can be provoked by repetitive jumping and attempts to strike a football hard with a straight leg.

INVESTIGATIONS

X-ray may show fragmentation of the symphysis but this is also a common finding in asymptomatic players. MRI may show bone oedema but again this can be seen in asymptomatic players during the season. A bone scintigram may show localised increased uptake. Usually it takes a long time to reach this diagnosis.

TREATMENT

This injury often responds to conservative treatment including modification of training and stretching exercises combined with core stability training.

REFERRALS

Refer to a physiotherapist for planning of a six months’ return programme back to sport. Seek advice from a urologist or gynaecologist if the symptoms are vague.

EXERCISE PRESCRIPTION

Cycling and water exercises are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

This is an unusual condition but one often suggested in referrals. Most pain in this area is secondary to core stability problems.

PROGNOSIS

Good-Fair,but the symptoms can be very long-lasting.

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