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Joseph Junewick, MD FACR
over 5 years ago
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Osteitis Pubis

Case Detail

Anatomy: Musculoskeletal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

Teenage soccer player with groin pain.


Case Images


Diagnosis

Osteitis Pubis

Findings

MR – Coronal fat-suppressed T2 and IR and axial T1 and fat-suppressed T2 and post-gadolinium T1 images of the pelvis show symmetric marrow edema and enhancement.

Discussion

Osteitis pubis, also referred to as rectus abdominus adducoris syndrome, is a chronic inflammatory process. The underlying pathophysiology is related to traction microtrauma occurring at the symphysis pubis. The rectus abdominus and internal and external oblique muscles insert into the inguinal ligament, conjoint tendon and symphysis pubis. The pectineus, gracilis, adductor magnus, adductor longus, and adductor brevis originate near the symphysis pubis. These two major muscle groups work to stabilize the pelvis.

Osteitis pubis is fairly common in athletes but often difficult to differentiate from other groin injuries. Activities with jumping, twisting, sprinting, kicking, and/or directional change (e.g., soccer, football, lacrosse, hockey, trail running) are prone to osteitis pubis. Patients are focally tender over the symphysis pubis. When minor, symptoms are usually most bothersome before and after sports activity. As the disease progresses, symptoms are debilitating.

Treatment is usually conservative and involves antiinflammatory medications, increasing flexability (particularly the adductor muscles) and strength (particularly the abdominal muscles), and correcting muscle imbalances.

Reference

Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis pubis syndrome in the professional soccer athlete: A case report. J Athletic Training (2001); 36(4):437-440.



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