Osteitis Pubis in Athletes

Abstract

Medical records of 59 patients (9 females and 50 males), who presented to sports medicine clinics at the Australian Institute of Sport and the University of British Columbia between 1985 and 1990 and who were diagnosed as suffering osteitis pubis, were reviewed and comparison of data obtained was made with the literature. Women average 35.5 years of age (30 to 59 years) and men 30.3 years (13 to 61 years). Sports most frequently involved were running, soccer, ice hockey and tennis. Clinical presentations of osteitis pubis fell into 4 main groups. 'Mechanical' (sport-related) was the largest group (n = 48), followed by 'obstetric' (n = 5), 'inflammatory' (n = 4) and 'other' (n = 2). Period of follow-up averaged 10.3 months (1 to 20 months) in women and 17.5 months (2 to 96 months) in men. Full recovery, when documented, averaged 9.5 months in men and 7.0 months in women. Osteitis pubis recurred in 25% of these men and none of these women at follow-up. The most frequent symptoms were pubic pain and adductor pain. Men also presented with lower abdominal, hip and perineal or scrotal pain; women with hip pain. Most common signs were tenderness of the pubic symphysis and tenderness of adductor longus muscle origin. Men also revealed tenderness of one or both the superior pubic rami and evidence of decreased hip rotation (unilateral or bilateral). Evidence of pelvic malalignment and/or sacroiliac dysfunction was frequently seen in both men and women. There was poor correlation between radiographic and isotope bone scan findings and the site and duration of symptoms and signs. Femoral head ratios were estimated on 30 hips in the series and 2 were judged to be at the upper limit of normal, perhaps indicating a form of epiphysiolysis producing tilt deformity of the head of the femur. It is clear that osteitis pubis in athletes is not uncommon and that factors such as loss of rotation of hips and previous obstetric history are important in the aetiology and management of this condition. Pelvic infection, which was believed to be the primary factor of osteitis pubis in the literature up until the 1970s, plays a very small role in this condition in athletes.

Aquatic Exercise Compared to Contrast Therapy With Shallow Water Treadmill Running to Assist Recovery in Elite Australian Rules Footballers

“…It is likely that this decrease in pain reduced muscle inhibition, which allowed greater muscle activation and consequently an increase in force production during the squeeze test. This is an encouraging finding as groin pain is common in AFL where there are high levels of side to side, twisting, and kicking movements (Fricker, Taunton, & Ammann, 1991). Groin pain is consistently among the top three causes for missed playing time in the AFL and has a high rate of recurrence and a risk of becoming chronic (Orchard & Seward, 2010).…”

Groin pain in sportsmen is not always musculotendinous in origin

“…Clinically therefore it is extremely difficult to distinguish between osteitis pubis and an underlying osteomyelitis. 1 Fortunately pyogenic infection of the symphysis pubis is uncommon. 2 A few series have reported these findings in diabetics, 3 4 intravenous drug abusers, 5 and patients recently undergoing urological intervention.…”

Osteitis pubis in elite athletes: Diagnostic and therapeutic approach

“…Sports hernia, inguinal wall deficiency, iliopsoas strain, stress and avulsion fractures, intraarticular hip joint injury or other relevant pathology such as snapping hip syndrome, referred low back pain and nerve compression, genitourinary and pubic septic infection should be ruled out [1,11,16,21,22] . It has been thought until the 1970s that a principal cause leading to OP was pelvic infection, which yet has been proven to have a minor contribution to the development of OP [23] . Those two clinical entities, though have a similar presentation.…”

“…A bone scan is also an assistant tool for the investigation of some other musculoskeletal pathologies such as stress fracture or osteomyelitis [1] . Nevertheless poor correlation between isotope bone scan findings and the location and duration of symptoms has been reported [23] .…”