Osteitis Pubis

Ovid: 5-Minute Sports Medicine Consult, The

Osteitis Pubis
Nadya Volsky
Robert L. Jones
  • Chronic inflammatory, painful condition secondary to stress forces through the anterior pelvis involving the pubic bones, pubic symphysis, and adjacent structures as a result of either chronic overloading or impaction trauma
  • Anterior pelvic ache or sharp pain that is worse with activities involving twisting/kicking
  • Located over the symphysis
  • May radiate into the lower abdominal muscles, perineum, and thigh adductors
  • May have associated adductor spasm
  • Can be provoked by standing on one leg or resisted hip adduction
  • Synonym(s): Pubic symphysis enthesopathy; Pubic symphysitis; Osteochondritis of pubic symphysis; Athletic pubalgia
  • Depends on type of sport; groin pain in general is seen in 2–5% of all sports injuries.
  • In sports that involve excessive twisting and turning movements such as soccer, ice and field hockey, tennis, and Australian-rules football, groin injuries may rise to 5–7% of all injuries.
  • Difficult to separate from possible coexisting conditions and to diagnose
  • Pure incidence for osteitis pubis alone is not clear.
Risk Factors
  • Sports involving kicking, interval sprinting, and rapid changes of direction such as soccer, ice and field hockey, Australian-rules football, tennis
  • Skeletal immaturity, especially coupled with high training volume/competition demands
  • Hip adductor/abductor muscle imbalance (abductors normally are ∼20% stronger than adductors)
  • Possibly hip stiffness and decreased range of motion (ROM) in the hip joint
  • Sacroiliac (SI) joint dysfunction
  • Pelvic asymmetry
  • History of prior groin injury
  • Pregnancy and/or postpartum
  • Rheumatologic disorders, such as ankylosing spondylitis or rheumatoid arthritis involving SI joint
  • Infection following urologic or gynecologic procedure
  • Poorly understood; poorly studied
  • Likely includes combination of following: Adductor muscles injury or overuse, anterior pelvic instability
  • Possible correlation between decreased preseason hip rotational ROM and the development of osteitis pubis
Physical Exam
  • Tenderness with palpation over the symphysis and pubic rami
  • Pain with resisted adduction, stretching hip flexors, and rising from a seated position
Diagnostic Tests & Interpretation
  • X-rays:
    • Anteroposterior view of pelvis
    • 1-legged stance
    • In relatively acute cases, plain radiographs may be normal; in chronic cases, radiographs can show cystic changes, sclerosis, and widening or narrowing at the symphysis, osteophytes, bony irregularities, or resorption.
    • Instability may be evident on a 1-legged stance film (step-off >2 mm between the pubic rami in the vertical plane and/or symphyseal gap >7 mm between the pubic bones).
  • MRI:
    • Bone edema spanning the symphysis with cystic or other degenerative changes, adductor microtears, and fluid in symphysis area may be visible.
    • Associated pathologies such as tendon injuries, stress fractures, and SI or sacral injuries may be evident.
  • Bone scan: May show increased uptake at the symphysis, although it can take months to become positive
Differential Diagnosis
  • Most common:
    • Adductor dysfunction (adductor complex tendinopathy, adductor tendinitis, adductor strain) and sports hernia
    • Both also could coexist or proceed osteitis pubis.
  • Other:
    • Femoral neck stress fracture
    • Labral tear of hip
    • Sacroiliitis
    • Lumbar disk pathology
    • Inguinal hernia
    • Genitourinary disorders: Prostatitis in males, UTI in females, passing renal stones
    • Gynecologic problems in females: Ovarian cyst, endometriosis
    • Pelvic soft tissue tumors


733.5 Osteitis pubis

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