Abstract
Osteitis pubis causes localized tenderness over the symphysis pubis, pain radiating into the inner thigh, and a waddling gait. Radiographic changes consisting of erosion, sclerosis, and widening of the symphysis pubis are pathognomonic for osteitis pubis. This is a disease of the second through fourth decades, and girls and women are affected more frequently than are boys and men. Osteitis pubis occurs most commonly after bladder, inguinal, or prostate surgery and is thought to result from the hematogenous spread of infection to the relatively avascular symphysis pubis. Osteitis pubis can also occur without an obvious inciting factor or infection.
Keywords
osteitis pubis, pelvic pain, urinary tract infection, sepsis, thigh pain, waddling gait, ultrasound guided injection diagnostic sonography, magnetic resonance imaging
ICD-10 CODE M85.30
Keywords
osteitis pubis, pelvic pain, urinary tract infection, sepsis, thigh pain, waddling gait, ultrasound guided injection diagnostic sonography, magnetic resonance imaging
ICD-10 CODE M85.30
The Clinical Syndrome
Osteitis pubis causes localized tenderness over the symphysis pubis, pain radiating into the inner thigh, and a waddling gait. Radiographic changes consisting of erosion, sclerosis, and widening of the symphysis pubis are pathognomonic for osteitis pubis ( Fig. 88.1 ). This is a disease of the second through fourth decades, and girls and women are affected more frequently than are boys and men. Osteitis pubis occurs most commonly after bladder, inguinal, or prostate surgery and is thought to result from the hematogenous spread of infection to the relatively avascular symphysis pubis. Osteitis pubis can also occur without an obvious inciting factor or infection.
Signs and Symptoms
On physical examination, patients exhibit point tenderness over the symphysis pubis, and the pain may radiate into the inner thigh with palpation of the symphysis pubis. Patients may also have tenderness over the anterior pelvis. The pain of osteitis pubis is aggravated by running, kicking, pivoting on one leg, and lying on the side. Patients often adopt a waddling gait to avoid movement of the symphysis pubis ( Fig. 88.2 ). This dysfunctional gait may result in lower extremity bursitis and tendinitis, which can confuse the clinical picture and add to the patient’s pain and disability.
Testing
Plain radiography is indicated in all patients who present with pain thought to be emanating from the symphysis pubis, to rule out occult bony disorders and tumor. Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, prostate-specific antigen level, erythrocyte sedimentation rate, C-reactive protein, serum protein electrophoresis, and antinuclear antibody testing. Magnetic resonance imaging of the pelvis is indicated if an occult mass or tumor is suspected ( Fig. 88.3 ). Radionuclide bone scanning may be useful to exclude stress fractures not visible on plain radiographs. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.
