Age / Sex : 30 / F

Age / Sex : 30 year old,  female

Chief complaint :  Pubic pain

osteitis pubis

Discussion

Findings:  Pelvis radiograph shows irregular widening of pubic symphysis with focal marginal bone resorption on the left. MRI shows bilateral bone marrow edema in symphyseal bodies and focal bone destruction on the left, and focal linear increased signal intensity in the adjacent adductor muscles.

Diagnosis:

osteitis pubis

Discussion:

Osteitis pubis is a painful, noninfectious inflammatory condition that involves

the pubic bone, symphysis, and surrounding structures, usually caused by abnormal muscle forces acting on the symphysis pubis. Initially associated with

urologic procedures, osteitis pubis has been described as a complication of

various obstetrical and gynecological procedures including vaginal deliveries. An

incidence of approximately 2 to 3 percent has been observed after the

Marshall-Marchetti-Krantz urethropexy. Although the pathogenesis of osteitis

pubis is not clear, periosteal trauma seems to be an important initiating event.

Pain is the primary symptom associated typically with difficulty in ambulation

and the characteristic "waddling gait." A low grade fever, elevated sedimentation

rate, and mild leukocytosis may be observed. Radiographic findings which include

reactive sclerosis, rarefaction, and osteolytic changes lag behind the symptoms

by about 4 weeks. The major differential diagnosis is osteomyelitis; however, the

self-limiting nature and its response to nonantibiotic therapy indicates that

osteitis pubis is a separate clinical entity. As other differential diagnosis ankylosing spondylitis, psoriatic arthritis, hyperparathyroidism with subchondral resoprtion, and stress or insufficiency fracture should be included. Treatment is directed at the

associated inflammation with most minor cases responding to antiinflammatory

agents and bed rest. Other more recalcitrant cases require more involved therapy

including systemic steroids and rarely surgical resection. The diagnosis of

osteitis pubis should be considered when pelvic pain is present in association

with potential trauma to the symphysis pubis. Also, with more women participating

in sporting activities patients may present to the physician with osteitis pubis

related to athletic injury.

References:

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Johnson R. Osteitis pubis. Curr Sports Med Rep 2003;2(2):98-102.

Major NM, Helms CA. Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in athletes. Skeletal Radiol. 1997 Dec;26(12):711-7.

Lentz SS. Osteitis pubis: a review. Obstet Gynecol Surv. 1995 Apr;50(4):310-5.

Sexton DJ, Heskestad L, Lambeth WR, McCallum R, Levin LS, Corey GR. Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four

cases and review. Clin Infect Dis. 1993 Oct;17(4):695-700.

Osteitis pubis. Diagnosis of bone and joint disorder 3rd E, Resnick; section XI:2092-5