- Pubic bone inflammation: description
- PubMal inflammation: symptoms
- Pubertal inflammation: causes and risk factors
- Pubic bone inflammation: examinations and diagnosis
- Pubic: Treatment
- PubMal inflammation: disease course and prognosis
A Osteitis pubis (Osteitis pubis) is a painful non-infectious inflammation of the pubic symphysis, pubic bone and surrounding structures. Cause are usually repeated micro traumas, which result from faulty or overloaded. Above all, athletes, especially footballers, are affected. Find out more about the pubic bone infection here.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. M85
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Pubic bone inflammation: description
Pubic bone inflammation is a non-infectious inflammation of the pubic symphysis, pubic bone and the immediate surrounding structures. It is referred to in the jargon as Osteitis pubis, Symphysenosteitis or Pubalgia (Pubalgia).
The pubic inflammation especially affects athletes. Every year, about 0.5 to 7 percent of athletes suffer from pubic bone inflammation - especially footballers, but also other athletes such as basketball players and tennis players. Above all men in the average age of 30 years are affected. Women who develop pubic bone infection are on average around 35 years old. For the patients, the disease may mean that they have to give up any sporting activity in the longer term.
Pubic bone inflammation: what is the pubic bone?
The bony pelvis consists of the sacrum and the two hipbones. Each hip bone is in turn composed of three parts: pubis, ilium and ischium.
The two pubic bones form the front part of the bony pelvis. They are connected by a fibrocartilaginous connection, the pubic symphysis (symphysis). This holds the pelvic ring together and at the same time allows the pubic bones to shift by a few millimeters.
When standing on two legs, the load of the trunk is transferred from the spine to the legs. This pulling forces act on the symphysis. When standing on one leg or while walking, the pressure on the symphysis increases because additional weight is added from the leg.
In pregnant women, the released hormone relaxin makes the symphysis more mobile. This allows the child to emerge more easily through the bony pelvis at birth.
PubMal inflammation: symptoms
An important symptom of pubic bone inflammation is pain in the area of the symphysis and pubic rami. They can be so strong that those affected must limit or even refrain from sporting activities. The symphysis is clearly tender-painful; the surrounding area is partially swollen.
Sometimes the pain of a pubic bone infection is not limited to the symphysis and the pubic rami, but radiates into the groin, hip or perineal region. Pain in the lower abdomen and around the pelvic floor is also possible.
Also typical of pubic inflammation is the "onset pain". The pain is strongest when getting up after prolonged sitting and relax in uniform movements such as walking again. Jerky movements or climbing stairs cause the sufferer usually pain. If sport is still possible, the pain often only appears after the end of the physical strain or intensifies toward evening.
Fever is more likely to be a bacterial infection and is absent in pubic bone inflammation.
Pubertal inflammation: causes and risk factors
If the symphysis is stressed too much, it can lead to inflammation and the formation of scar tissue. Under certain circumstances, this can lead to the bone being broken down and cysts or stress fractures (stress-related fractures) to occur in adjacent bone regions.
Pubic inflammation is particularly common in sports where high tractive forces are acting on the symphysis. These include sports with many sprint and shot elements or quick changes of direction. As risk sports for a pubic bone inflammation, therefore, especially apply:
- American football
- Running sports
Pregnancy and childbirth can also be the cause of a pubic bone infection. In one study, bleeding in the symphysis and adjacent bone was detected in women after birth. In addition, cracks were visible in the cartilage. Whether this mechanism also takes place in athletes with pubic inflammation, can not say for sure.
Furthermore, in rare cases, pubic inflammation may be a complication of pelvic surgery. These include, for example, prostate surgery.Even when inserting a bladder catheter, which is inserted above the pubis through the abdominal wall into the bladder (suprapubic urinary catheter), a pubic bone infection can develop as a result.
Pubic bone inflammation: examinations and diagnosis
The diagnosis of pubic bone inflammation is not easy. The described pain can also occur in other sports injuries and illnesses. Thus, initially a groin strain, an adductor syndrome (overloading of certain tendons) or other painful diseases in the groin is suspected. Also, the hip joint is often suspected as a cause of pain. Overall, it is important to distinguish a pubic bone inflammation against the following diseases and injuries with similar symptoms:
- Bone marrow inflammation (osteomyelitis)
- Stress / fatigue fractures in the pelvic bone area
- Fracture fractures of the tendons
- Inguinal hernias
- Nerve entrapment syndromes
- Insertion dendinosis (chronic irritation of a tendon insertion on the bone)
- Adductor strain (adductor muscles on the inside of the thigh)
- Diseases of the urinary and genital tract
- Rheumatological diseases
- Neoplasms (neoplasms of tissue)
PubMal inflammation: anamnesis
To get to the bottom of the cause of the complaint, the doctor will first take the medical history (anamnesis) by talking at length to the patient. Possible questions include:
- Do you have pain while walking or climbing stairs?
- For example, can you stand on one leg while dressing?
- Where exactly is the pain?
- How long does the pain usually last?
- Do you do sports? If so, which one?
- When does the pain go away?
Pubic bone inflammation: physical examination
This is followed by a physical examination. In pubic bone inflammation, the doctor usually notes pressure pain over the symphysis or the pubic ram. In the so-called Symphyseal Klaff test, the doctor exerts pressure on certain tendon approaches (adductor approaches). If this causes pain to the patient, this may be an indication of a pubic bone infection.
PubMint: blood test
A blood test does not result in increased inflammatory parameters in pubic bone inflammation - in contrast to the rare septic inflammation of the symphysis, in which the inflammation levels are increased.
Pubic bone inflammation: Imaging procedures
Imaging techniques help diagnose a pubic bone infection. However, it is important to differentiate from infectious diseases, since the imaging is often similar, so that pubic inflammation and infectious inflammations are often difficult to distinguish from each other.
A X-ray is useful to exclude a stress fracture. In addition, pubic bone inflammation typically shows various changes in the X-ray image. These include compacted bone tissue beneath the cartilage (subchondral sclerosis), cystic changes, bony irregularities and erosions over the symphysis and the joint-proximate parts of the pubic rami. Often the symphysis gap (pubic symphysis) is widened.
Another imaging tool for suspected pubic inflammation is the scintigraphy, a nuclear medicine examination. Especially the 3-phase skeletal scintigraphy with technetium-99m is well suited to differentiate the pubic bone inflammation from the bone marrow inflammation. Pubic bone inflammation is detectable in early skeletal scintigraphy.
Also the MRI (Magnetic Resonance Imaging, MRI) provides a good way to delineate the pubic bone infection diagnostically. On MRI, osteitis pubis can be detected early on, namely in fluid accumulations in the bone (bone marrow edema) in the pubic region.
A pubic bone infection is a disease that usually heals itself. Therefore, it is initially treated conservatively. In persistent pubic inflammation in addition to the injection therapy is also the possibility of surgical treatment.
In general, the treatment of pubic bone inflammation requires a lot of patience, as it can sometimes take several months to become successful. During therapy, pain-inducing movements should be avoided at all costs.
Pubertal inflammation: therapy with conservative methods
When pubic bone is diagnosed for the first time, conservative treatments (including physiotherapy) are used. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac, temporarily help against the pain. In some cases, pubic bone inflammation must be treated with cortisone. Furthermore, ultrasound treatment, cryotherapy and electrotherapy can be supportive.
It is important to initially hold a sports break, then slowly back into training step by step. In particular, any effort should be avoided that leads to a heavy load on the pelvic girdle and adductors. If sports are restarted too soon, the pain can become chronic. This worsens the prognosis.
The physiotherapy of pubic bone inflammation should focus primarily on exercises that strengthen the trunk and pelvic floor muscles and stretch the adductor muscles.
Pubic Infarction: Invasive, non-operative therapy
If the symptoms persist despite analgesics and physiotherapy, an injection or infusion therapy can be tried.
Injection therapy: Cortisone and / or a local anesthetic are injected into the joint space. About 80 percent of patients subsequently report an improvement in their symptoms.
Infusion therapy: Another treatment option for cocaine inflammation is infusion therapy with bisphosphonates such as pamidronate. They inhibit bone loss. This form of therapy seems promising, but requires further scientific studies. So far, it is not officially approved for the treatment of pubic bone inflammation (but only for the treatment of osteoporosis), that is, bisphosphonates are used in Osteitis pubis only in "off-label use".
PubMal inflammation: surgical therapy
In chronic painful pubic inflammation, in which after months of conservative treatment no improvement occurs, surgery as a last resort measure can be considered. Before, any possible concomitant disease should be excluded.
An operation in pubic bone inflammation is always performed under general anesthesia. Especially in competitive athletes has been shown that a so-called curettage (scraping) leads to good results. This is scraping some tissue on the pubic symphysis. In rare cases, a joint stiffening (Arthodese) of the symphysis is performed. In this case, an endogenous bone chip is used, which is fixed with a plate.
PubMal inflammation: disease course and prognosis
In some cases, pubic bone inflammation heals spontaneously, sometimes even after prolonged discomfort for weeks to months. In other cases, osteitis pubis takes a long-lasting, extremely painful course with longer-term sports interruption. This requires a lot of stamina from the affected athlete, but also from the trainer, physiotherapist and attending physician. Conservative therapy is sufficient in most cases.
After treatment, when full freedom from pain has been achieved, sport can be exercised in the original way. As an exception, light running training can be started earlier, depending on the symptoms of the complaint.
Pubic Infection: Prevention
Certain measures can prevent a pubic bone infection. This involves warming up the whole body before exercise, stretching the adductors and specifically training the abdominal and trunk muscles to build and stabilize them. A false statics of the arch of the foot can be adjusted by suitable inserts. Muscular imbalances between agonists and antagonists (muscular antagonists) should, if possible, be compensated. Mobility disorders of the sacroiliac joint, ie the articulated connection between the sacrum and the ilium, can be restored by manual medical methods. Everything together can help one Osteitis pubis submissions.