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CMAJ : Canadian Medical Association... Apr 2021
Topics: Accidents, Traffic; Adult; Bandages; Emergency Service, Hospital; First Aid; Hematoma; Humans; Motorcycles; Pubic Symphysis Diastasis; Radiography, Abdominal; Sacroiliac Joint; Tomography, X-Ray Computed
PubMed: 33903137
DOI: 10.1503/cmaj.201114-f -
Annals of Anatomy = Anatomischer... Jul 2021Conflicting anatomical reports and the little attention given to the pubic ligaments impede the interpretation of radiological and clinical examinations on groin pain....
BACKGROUND
Conflicting anatomical reports and the little attention given to the pubic ligaments impede the interpretation of radiological and clinical examinations on groin pain. Morphometric data on the pubic ligaments are lacking.
METHODS
The muscular relations of the symphysis pubis were examined in layered dissection (n = 10), hemipelves (n = 60) and (un)stained plastinated body slices of body donors (n = 3). The sagittal and coronal areas, width, mean and maximum thickness of pubic ligaments were determined.
RESULTS
The adductor longus, brevis, rectus abdominis and pyramidalis muscles are attached to the anterior pubic ligament (APL). The adductor brevis and gracilis muscle are connected to the inferior pubic ligament (IPL). The IPL and superior pubic ligament (SPL) are thicker than the APL and posterior pubic ligament (PPL). The PPL is the thinnest pubic ligament. The APL has a larger sagittal area in women than in men compared to the IPL. The SPL and IPL are thicker in men compared to women.
CONCLUSION
The APL is the ligamentous anchor for the originating and inserting muscles. Investigations of the pubic ligaments might help to determine symphysis instability or severity of injury and should be included as a further criterion for surgical management.
Topics: Female; Humans; Ligaments; Ligaments, Articular; Male; Muscle, Skeletal; Pubic Symphysis; Thigh
PubMed: 33582299
DOI: 10.1016/j.aanat.2021.151698 -
SAGE Open Medical Case Reports 2021Lumbo-pelvic pain is a common and non-specific problem during pregnancy and postpartum. Although perinatal pyogenic sacroiliitis is uncommon during this time, it might...
Lumbo-pelvic pain is a common and non-specific problem during pregnancy and postpartum. Although perinatal pyogenic sacroiliitis is uncommon during this time, it might be difficult to distinguish from reactive sacroiliitis in women who are experiencing significant lower back and pelvic girdle pain, as the symptoms and signs are not clear and the tests are not definitive. A 34-year-old primigravida went to the emergency department with severe lower back pain radiating to the right gluteal region and down to the back of the right thigh. This pain began 12 days prior to her presentation and eventually worsened to the point that she could not stand or walk. Her vital signs were within normal ranges, and she was experiencing a fever. Apart from a slight widening of the symphysis pubis, her pelvic and lumbo-sacral pain X-rays revealed no important findings. With the clinical impression of right lumbo-pelvic pain, the patient was admitted for pain management and further inquiries. Despite the fact that the antibiotherapy was prescribed to treat a urinary tract infection, the significant recovery of the patient's symptoms, even in the absence of a definitive culture of aspirate from the right sacroiliac joint, supported the diagnosis of pyogenic sacroiliitis.
PubMed: 34659772
DOI: 10.1177/2050313X211052442 -
Cureus Mar 2022Osteitis pubis (OP) is a self-limiting, noninfectious inflammatory disease of the pubic symphysis and the surrounding soft tissues that usually improves with... (Review)
Review
Osteitis pubis (OP) is a self-limiting, noninfectious inflammatory disease of the pubic symphysis and the surrounding soft tissues that usually improves with activity modification and targeted conservative treatment. Surgical treatment is required for a limited number of patients. This study aims to investigate the current literature on the surgical treatment of OP in athletes. A systematic review was conducted on two databases (MEDLINE/PubMed and Google Scholar) from 2000 to 2021. The inclusion criteria were adult patients with athletic OP who underwent surgical treatment and studies published in English. The exclusion criteria included pregnancy, infection OP, or postoperative complications related to other surgical interventions, such as urological or gynecological complications. Fifty-one surgically treated cases have been reported in eight studies, which included short-term, mid-term, and long-term studies ranging from one patient to 23 patients. The surgical treatment methods were as follows: (a) pubic symphysis arthrodesis, (b) open or endoscopic pubic symphysectomy, (c) wedge resection of the pubic symphysis, and (d) polypropylene mesh placed into the preperitoneal retropubic space endoscopically. The main indication for surgical intervention was failure of conservative measures and long-lasting pain, disability, and inability to participate in athletic activities. Wedge resection of the pubic symphysis has been the less preferred surgical treatment in the recently published literature. The most common surgical method of treatment of OP in athletes, which entailed the existence of posterior stability of the sacroiliac joint, in the current literature is open pubic symphysis curettage. Recently, there has been a tendency for pubic symphysis curettage to be performed endoscopically.
PubMed: 35464551
DOI: 10.7759/cureus.22976 -
BMJ Case Reports Jan 2019A 57-year-old man presented with a 6-month history of pelvic fullness. He had no lower urinary tract symptoms or altered bowel habits. On examination, there was a...
A 57-year-old man presented with a 6-month history of pelvic fullness. He had no lower urinary tract symptoms or altered bowel habits. On examination, there was a non-tender pelvic mass which extended from the pubic symphysis to the level of the umbilicus. CT scan of the abdomen demonstrated a 22×11×11 cm cystic mass arising from the pelvis extending into the midline and superiorly to the umbilicus. Other than raised carcinoembryonic antigen of 7.6 ng/mL (<5.0), the remainder of his blood test were unremarkable. Flexible cystoscopy demonstrated a convex deformity of the bladder wall in keeping with the compression and displacement as seen on the CT. The patient underwent an open excision of the cystic structure (urachal remnant), partial cystectomy, partial excision of anterior abdominal wall and pelvic lymphadenectomy. A check cystogram performed 12 days following the initial operation was unremarkable.
Topics: Abdominal Wall; Aftercare; Carcinoembryonic Antigen; Cystadenocarcinoma, Mucinous; Cystectomy; Cystoscopy; Humans; Lymph Node Excision; Male; Middle Aged; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome; Urachus; Urinary Bladder Neoplasms
PubMed: 30674499
DOI: 10.1136/bcr-2018-228089 -
BJUI Compass Jul 2022The objective of this study is to summarise the contemporary evidence regarding the prevalence, diagnosis, and management of osteitis pubis (OP) specially from... (Review)
Review
OBJECTIVE
The objective of this study is to summarise the contemporary evidence regarding the prevalence, diagnosis, and management of osteitis pubis (OP) specially from urological point of view, while proposing an algorithm for the best management based on the current evidence.
METHODS
We performed a literature search using the PubMed database for the term 'osteitis pubis' until December 2020. We assessed pre-clinical and clinical studies regarding the aetiology, pathophysiology, and management of OP. Case reports and case series were evaluated by study quality and patient outcomes to determine a potential clinical management algorithm.
RESULTS
Osteitis pubis is a chronic painful condition of the symphysis pubis joint and its surrounding structures. Still, there is a paucity of data outlining the management plan and the possible triggers. The aetiology seems to be multifactorial with different proposals trying to explain the pathophysiology and correlate the findings to the outcome. The diagnosis is usually based on high suspicion index and clinical experience. The infective variant of the disease is aggressive and requires strict and active management. Universal consensus is still lacking regarding a formal algorithm of management of the condition, especially due to multiple specialities involved in the decision-making process. Conservative management remains the cornerstone; nevertheless, surgical interventions may be needed in special settings. Hence, a multi-disciplinary approach is of pivotal value in fashioning the plan for each case. The prognosis is usually satisfactory; however, a longstanding debilitating disease form is not uncommon.
CONCLUSION
OP remains a rare condition with real challenges in its diagnosis. The current management is focused on conservative management; however, surgical intervention is still needed in some difficult scenarios. Continued research into the triggers of OP, multidisciplinary approach, and standardised clinical pathways can improve the quality of care for patients suffering from this condition.
PubMed: 35783593
DOI: 10.1002/bco2.127 -
Acta Ortopedica Brasileira 2022Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are...
INTRODUCTION
Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players.
MATERIALS AND METHODS
An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV).
RESULTS
A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001).
CONCLUSION
There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis.
PubMed: 35431631
DOI: 10.1590/1413-785220223001e244380