Symphyseal Cleft Injection in the Diagnosis and Treatment of Osteitis  Pubis in Athletes

O’Connell, Martin; Powell, T.; McCaffrey, Noel; O’Connell, D.; Eustace, Stephen

doi:10.2214/ajr.179.4.1790955

Cited by 117 publications

(61 citation statements)

References 12 publications

(15 reference statements)

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“…Bone marrow edema is claimed to reflect impaction forces causing subarticular microtrabecular trauma (10). Marrow changes are likened to the changes seen in the vertebral endplates in patients with degenerative disease of the spine (8,10). In contrast to these reports we detected bone marrow edema especially in clinically acute and subacute cases rather than chronic ones.…”

Section: Discussioncontrasting

confidence: 69%

“…The abdominal muscles, rectus abdominis and external and internal oblique, attach distally to the inguinal ligament, conjoined tendon, and the pubic symphysis, whereas the adductor muscles, pectineus, adductor longus, adductor brevis, adductor magnus, and gracilis, originate from the superior and inferior rami of the pubis (1). The abdominal muscles act synergistically with the paravertebral muscles to stabilize the symphysis during single-leg stance and maintain balance while kicking (8). The adductors counteract with the abdominal muscles in stabilizing the symphysis and bring the lower extremity closer to the pelvis (1).…”

Section: Discussionmentioning

confidence: 99%

“…In fact pelvic springing was positive in 18 and gap test in 11 patients. Reported radiographic findings of osteitis pubis are articular surface irregularity, asymmetrical bony resorption with sclerotic bony margins, and osteophyte formation (3,8). Flamingo views are recommended in addition to standard pelvic radiographs to confirm symphyseal instability (2,6).…”

Section: Discussionmentioning

confidence: 99%

“…Multiplanar imaging allows detection of step-off at the pubic articular surfaces in either the vertical or horizontal planes (8). A step-off more than 2 mm or symphyseal gap more than 7 mm in flamingo x-rays are considered criteria for symphyseal laxity or instability (6).…”

Section: Discussionmentioning

confidence: 99%

“…Other reported MRI findings associated with osteitis pubis are irregularity of the bony margins of the symphysis, pubic ramus sclerosis, and adductor avulsion (3,8). We determined bony margin irregularity and subchondral sclerosis in most of the cases (16 and 14 cases, respectively).…”

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance findings of osteitis pubis

Kunduracioglu

Yılmaz

Yörübulut³

et al. 2007

Magnetic Resonance Imaging

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Purpose:To determine the correlation of MR findings with clinical features of osteitis pubis and to look for associating injuries complicating chronic cases. Materials and Methods:Pelvic MR images of the 22 elite athletes with groin pain were taken. Correlation analysis between the MR findings and clinical properties was carried out. Results:Six of the MR findings had strong correlation with duration of symptoms. Subchondral bone marrow edema, fluid in symphysis pubis joint, and periarticular edema had significant correlation with acuity of the case. On the contrary, subchondral sclerosis, subchondral resorption and bony margin irregularities, and osteophytes correlated with the chronicity of the case. Associated tendon injuries correlated with the duration of symptoms; i.e., all tendon injuries were in chronic cases. Conclusion:Subchondral bone marrow edema, fluid in symphysis pubis joint, and periarticular edema are the most reliable MRI findings of osteitis pubis that has a history of less than six months. Subchondral sclerosis, subchondral resorption and bony margin irregularities, and osteophytes (or pubic beaking) are the most reliable MRI findings of the chronic disease that has been present for more than six months. Associated pathologies, especially adductor or other tendon injuries, underlie more than half of the chronic cases of osteitis pubis.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance findings of osteitis pubis

Kunduracioglu

Yılmaz

Yörübulut³

et al. 2007

Magnetic Resonance Imaging

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How do you Treat Chronic Groin Pain?

Fricker

Lovell²

2007

Evidence‐based Sports Medicine

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The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence

et al. 2022

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Objective: The objective of this study is to summarise the contemporary evidence regarding the prevalence, diagnosis, and management of osteitis pubis (OP) specially from urological point of view, while proposing an algorithm for the best management based on the current evidence. Methods:We performed a literature search using the PubMed database for the term 'osteitis pubis' until December 2020. We assessed pre-clinical and clinical studies regarding the aetiology, pathophysiology, and management of OP. Case reports and case series were evaluated by study quality and patient outcomes to determine a potential clinical management algorithm.Results: Osteitis pubis is a chronic painful condition of the symphysis pubis joint and its surrounding structures. Still, there is a paucity of data outlining the management plan and the possible triggers. The aetiology seems to be multifactorial with different proposals trying to explain the pathophysiology and correlate the findings to the outcome. The diagnosis is usually based on high suspicion index and clinical experience.The infective variant of the disease is aggressive and requires strict and active management. Universal consensus is still lacking regarding a formal algorithm of management of the condition, especially due to multiple specialities involved in the decision-making process. Conservative management remains the cornerstone; nevertheless, surgical interventions may be needed in special settings. Hence, a multi-disciplinary approach is of pivotal value in fashioning the plan for each case.The prognosis is usually satisfactory; however, a longstanding debilitating disease form is not uncommon. Conclusion:OP remains a rare condition with real challenges in its diagnosis. The current management is focused on conservative management; however, surgical intervention is still needed in some difficult scenarios. Continued research into the triggers of OP, multidisciplinary approach, and standardised clinical pathways can improve the quality of care for patients suffering from this condition.

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Symphyseal Cleft Injection in the Diagnosis and Treatment of Osteitis Pubis in Athletes

Abstract: Symphyseal cleft injection is a useful technique for the diagnosis and treatment of osteitis pubis in athletes. The procedure is well tolerated and may facilitate early resumption of competitive duties.

Cited by 117 publications

References 12 publications

Magnetic resonance findings of osteitis pubis

Magnetic resonance findings of osteitis pubis

How do you Treat Chronic Groin Pain?

The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence

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