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Osteitis Pubis
Kirkland W. Davis, MD, FACR; Adam C. Zoga, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Osteitis pubis (OP)
                • Pubic symphysis (PS)
              • Synonyms

                • Athletic OP, posttraumatic OP, pubalgia osteitis
              • Definitions

                • Painful chronic overuse injury of PS
                  • PS is focus of numerous dynamic and static forces
                • Subchondral osseous changes at PS as response to instability, overuse
                • Posttraumatic OP may result from
                  • Trauma with destabilization of PS
                  • Pregnancy (destabilization 2° to ligamentous laxity)
                  • Sports hernia (tear of inferior rectus abdominis, extending into origin of adductor longus)
                • Normal PS consists of apposing pubic bodies covered by articular cartilage, with intervening fibrocartilaginous disc
                  • Primary cleft often present within the disc (normal)
                  • Joint supported by ligaments; arcuate (inferior pubic) ligament strongest
                  • Pubic bodies serve as attachment sites for multiple adductors, rectus abdominis, midline pubic plate, inguinal ligament

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          • Ultrasonographic Findings

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Staging, Grading, & Classification

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Coker DJ et al: The role of magnetic resonance imaging in athletic pubalgia and core muscle injury. Top Magn Reson Imaging. 24(4):183-91, 2015
                                                2. Budak MJ et al: There's a hole in my symphysis—a review of disorders causing widening, erosion, and destruction of the symphysis pubis. Clin Radiol. 68(2):173-80, 2013
                                                3. Hopp SJ et al: Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 133(7):1003-9, 2013
                                                4. Khan W et al: Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 21(1):97-110, 2013
                                                5. Palisch A et al: Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med. 32(3):427-47, 2013
                                                6. Weber MA et al: Groin pain in athletes. Rofo. 185(12):1139-48, 2013
                                                7. Balconi G: US in pubalgia. J Ultrasound. 14(3):157-66, 2011
                                                8. Choi H et al: Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. 45(1):57-64, 2011
                                                9. Hiti CJ et al: Athletic osteitis pubis. Sports Med. 41(5):361-76, 2011
                                                10. Garvey JF et al: Sportsman hernia: what can we do? Hernia. 14(1):17-25, 2010
                                                11. Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
                                                12. Pizzari T et al: Prevention and management of osteitis pubis in the Australian Football League: a qualitative analysis. Phys Ther Sport. 9(3):117-25, 2008
                                                13. Zoga AC et al: Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 247(3):797-807, 2008
                                                14. Cunningham PM et al: Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. 188(3):W291-6, 2007
                                                15. Brennan D et al: Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 235(1):162-7, 2005
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Abbreviations

                                                              • Osteitis pubis (OP)
                                                              • Pubic symphysis (PS)
                                                            • Synonyms

                                                              • Athletic OP, posttraumatic OP, pubalgia osteitis
                                                            • Definitions

                                                              • Painful chronic overuse injury of PS
                                                                • PS is focus of numerous dynamic and static forces
                                                              • Subchondral osseous changes at PS as response to instability, overuse
                                                              • Posttraumatic OP may result from
                                                                • Trauma with destabilization of PS
                                                                • Pregnancy (destabilization 2° to ligamentous laxity)
                                                                • Sports hernia (tear of inferior rectus abdominis, extending into origin of adductor longus)
                                                              • Normal PS consists of apposing pubic bodies covered by articular cartilage, with intervening fibrocartilaginous disc
                                                                • Primary cleft often present within the disc (normal)
                                                                • Joint supported by ligaments; arcuate (inferior pubic) ligament strongest
                                                                • Pubic bodies serve as attachment sites for multiple adductors, rectus abdominis, midline pubic plate, inguinal ligament

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Nuclear Medicine Findings

                                                                      • Imaging Recommendations

                                                                        • Ultrasonographic Findings

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Staging, Grading, & Classification

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Coker DJ et al: The role of magnetic resonance imaging in athletic pubalgia and core muscle injury. Top Magn Reson Imaging. 24(4):183-91, 2015
                                                                                              2. Budak MJ et al: There's a hole in my symphysis—a review of disorders causing widening, erosion, and destruction of the symphysis pubis. Clin Radiol. 68(2):173-80, 2013
                                                                                              3. Hopp SJ et al: Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 133(7):1003-9, 2013
                                                                                              4. Khan W et al: Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 21(1):97-110, 2013
                                                                                              5. Palisch A et al: Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med. 32(3):427-47, 2013
                                                                                              6. Weber MA et al: Groin pain in athletes. Rofo. 185(12):1139-48, 2013
                                                                                              7. Balconi G: US in pubalgia. J Ultrasound. 14(3):157-66, 2011
                                                                                              8. Choi H et al: Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. 45(1):57-64, 2011
                                                                                              9. Hiti CJ et al: Athletic osteitis pubis. Sports Med. 41(5):361-76, 2011
                                                                                              10. Garvey JF et al: Sportsman hernia: what can we do? Hernia. 14(1):17-25, 2010
                                                                                              11. Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
                                                                                              12. Pizzari T et al: Prevention and management of osteitis pubis in the Australian Football League: a qualitative analysis. Phys Ther Sport. 9(3):117-25, 2008
                                                                                              13. Zoga AC et al: Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 247(3):797-807, 2008
                                                                                              14. Cunningham PM et al: Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. 188(3):W291-6, 2007
                                                                                              15. Brennan D et al: Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 235(1):162-7, 2005