The adult human pubic symphysis: a systematic review

Abstract

The pubic symphysis is a unique joint consisting of a fibrocartilaginous disc sandwiched between the articular surfaces of the pubic bones. It resists tensile, shearing and compressive forces and is capable of a small amount of movement under physiological conditions in most adults (up to 2 mm shift and 1°rotation). During pregnancy, circulating hormones such as relaxin induce resorption of the symphyseal margins and structural changes in the fibrocartilaginous disc, increasing symphyseal width and mobility. This systematic review of the English, German and French literature focuses on the normal anatomy of the adult human pubic symphysis. Although scientific studies of the joint have yielded useful descriptive data, comparison of results is hampered by imprecise methodology and ⁄ or poorly controlled studies. Several aspects of the anatomy of the pubic symphysis remain unknown or unclear: the precise attachments of surrounding ligaments and muscles; the arrangement of connective tissue fibres within the interpubic disc and the origin, structure and function of its associated interpubic cleft; the biomechanical consequences of sexual dimorphism; potential ethnic variations in morphology; and its precise innervation and blood supply. These deficiencies hinder our understanding of the normal form and function of the joint, which is particularly relevant when attempting to understand the mechanisms underlying pregnancy-related pubic symphyseal pain, a neglected and relatively common cause of pubic pain. A better understanding of the normal anatomy of the human pubic symphysis should improve our understanding of such problems and contribute to better treatments for patients suffering from symphyseal pain and dysfunction.

Severe Pubic Symphysis Diastasis Managed Conservatively: A Case Report and Review

“…The risk of rupture further increases during childbirth due to variable stress on these ligaments. In our case, it is evident that these ligaments underwent significant stress during the conclusion of the second stage of labor [1].…”

“…Vascularity to the pubic symphysis is supplied by branches of the obturator artery, inferior epigastric arteries, internal pudendal arteries, and medial circumflex femoral artery. Innervation comes from the branches of the pudendal, genitofemoral, iliohypogastric, and ilioinguinal nerves [1]. Fortunately, there was no evidence of neurovascular trauma in our patient.…”

Tuberculosis of the Pubic Symphysis: Four Unusual Cases and Literature Review

“…The inferior pubic or arcuate ligament is the strongest stabilizing structure. The pubic symphysis receives its blood supply from the inferior epigastric, pudendal, medial circumflex femoral and obturator arteries [8]. TB of the pubic symphysis is mostly blood borne [3] (as in our Patient 4 with multisystem TB) and the infection spreads hematogenously to the metaphyseal bone and the fibrocartilage of the pubis.…”

Chiropractic Management of Pubic Symphysis Shear Dysfunction in a Patient With Overactive Bladder

“…59 Highly stressed anatomic positions cause only about 1 mm of displacement as seen in radiography. 60 Ruch has written that standard lumbopelvic radiography may commonly result in false negatives in looking for pubic shear.…”

“…64 The pudendal and genitofemoral nerves, as well as branches of the iliohypogastric and ilioinguinal nerves, innervate the symphysis pubis. 59 The pelvic, hypogastric and pudendal nerves also carry sensory information in afferent fibers from the lower urinary tract to the lumbosacral spinal cord. 65 Pelvic nerve afferents monitor bladder urinary volume and bladder contraction during voiding, thus initiating and reinforcing micturition.…”