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British Medical Journal Oct 1974In a radiological study of the pubic symphysis in 37 athletes (26 footballers and 11 others) and 156 young men as controls changes similar to those of osteitis pubis...
In a radiological study of the pubic symphysis in 37 athletes (26 footballers and 11 others) and 156 young men as controls changes similar to those of osteitis pubis were found in 19 (76%) of the footballers and nine of the other athletes (81%) and 70 of the controls (45%). In the controls there was a significant correlation between their athletic ability and these changes.The clinical features consist of pain in the region of the pubis which may radiate to the groin or lower abdomen. Clicking may be present and indicates instability. Local tenderness is the only significant sign. Radiographs may show a combination of marginal irregularity, reactive sclerosis, and instability.A chronic stress lesion in the iliac component of a sacro-iliac joint was found in 20 out of 37 athletes, and 13 of them had instability at the pubic symphysis.It is concluded that repeated minor trauma is the primary aetiological factor. Though the radiological appearance may resemble that of osteitis pubis, there was no evidence that infection caused the lesion in this series. Spontaneous remission of symptoms is the most likely outcome. Rest from physical exertion is the most effective treatment, and stabilization of the pubic symphysis is indicated only rarely.
Topics: Adolescent; Adult; Athletic Injuries; Diagnosis, Differential; Humans; Joint Diseases; Male; Osteitis; Phenylbutazone; Pubic Symphysis; Radiography; Rest; Sacroiliac Joint; Sclerosis; Sports; Sports Medicine
PubMed: 4422968
DOI: 10.1136/bmj.4.5938.211 -
Physical Therapy Apr 2022Pregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women's lives. There is uncertainty regarding the association between...
OBJECTIVE
Pregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women's lives. There is uncertainty regarding the association between the structures of the bony pelvis, diastasis recti abdominis (DRA), pain processing, and PGP and to what extent these factors should be considered during physical therapy. This study aimed to evaluate the differences between women with and without PGP shortly after delivery regarding the separation of a pubic symphysis, DRA, and pain catastrophizing.
METHODS
Women diagnosed with PGP 24 to 72 hours after vaginal delivery were matched to pain-free controls according to age and parity. Ultrasound evaluations of diastasis recti (interrecti distance [IRD]) during rest and curl-up task and pubic symphysis (interpubic width) were performed. The Pain Catastrophizing Scale was used to assess the level of catastrophizing. A special Cox regression model was used to fit a conditional logistic regression for a 1:2 matched case-control study.
RESULTS
Thirty-five women with clinically diagnosed PGP and 70 matched controls were included in the study. The PGP group had a significantly higher pre-pregnancy body mass index than the control group. After adjusting for body mass index in multiple conditional logistic regression, the interpubic distance (odds ratio = 1.64; 95% CI = 1.22 to 2.20) and IRD during curl-up (odds ratio = 2.01; 95% CI = 1.08 to 3.74) were significantly associated with PGP. Pain catastrophizing and IRD at rest were not associated with PGP in univariable or multivariable analysis.
CONCLUSIONS
Pain catastrophizing is similar for women with and without PGP early postpartum. However, the degree of the pubic symphysis and rectus abdominis separation during the curl-up task are positively associated with PGP shortly after delivery.
IMPACT
This study indicates that a reconsideration of the way we look at DRA is warranted. The development of a more comprehensive assessment including objective measurements and a biopsychosocial understanding is needed to inform directions for further postpartum physical therapy.
Topics: Case-Control Studies; Catastrophization; Diastasis, Muscle; Female; Humans; Pelvic Girdle Pain; Pregnancy; Pubic Symphysis; Rectus Abdominis
PubMed: 35079827
DOI: 10.1093/ptj/pzab311 -
Journal of Clinical and Diagnostic... Jan 2016The symphysis pubis is formed at the confluence of the pubic bones. Each pubic bone consists of a body and two rami; the superior ramus is joined with the ilium and the...
INTRODUCTION
The symphysis pubis is formed at the confluence of the pubic bones. Each pubic bone consists of a body and two rami; the superior ramus is joined with the ilium and the inferior ramus with the ischium. The two bones meet in the midline at the pubic symphysis. The two inferior rami at the lower border of pubic symphysis subtend the subpubic angle. In females the subpubic angle is more than 90° and in males it is less than 90°. Most of the previous studies on the subpubic angle have been in children or adults, therefore data on fetuses did merit.
AIM
The aims of the present study were to measure the subpubic angle in developing human fetuses of different gestational age, whether it is sex dependent and to compare the results with that in the adults.
MATERIALS AND METHODS
A cross-sectional study conducted in the Department of Anatomy JN Medical College, AMU Aligarh, over a period of two years. A total of 41 fetuses immersion fixed in 10% formalin were obtained from the museum department of anatomy. For the purpose of study fetuses were divided into five groups according to gestational age. Group I comprises fetuses of 14-18weeks, group II 19-22weeks, group III 23-26weeks, group IV 27-30weeks, groupV >30weeks of gestation. Pubic symphyses were dissected, cleaned and subjected to radiological examination in the anteroposterior plane. With the help of radiographs subpubic angle was measured. Readings obtained were analysed statistically.
RESULTS
Subpubic angle ranged between 58°-64° throughout intrauterine life. Maximum angle (63°- 64°) was observed in group I and V and in the rest of the groups it was less than 60°, with highly significant (p-value<0.001) increase in the last group. Statistically significant sexual dimorphism was observed in group I and II fetuses (p-value <0.001). Subpubic angle was more in females during the first half and in the terminal part of gestation.
CONCLUSION
Subpubic angle remained acute throughout the intrauterine life, with significant widening in fetuses more than 30 weeks of gestation. Marked sexual dimorphism was noticed only in fetuses of 14-18 weeks and 19-22 weeks of gestation fetuses, although the values were invariably less than 90° (acute) in both the sexes but in females towards the higher side as in adults. Assessment of symphysis and subpubic arch during antenatal ultrasonography of pregnant women can be done to diagnose congenital widening of the symphysis or absence of symphysis altogether.
PubMed: 26894049
DOI: 10.7860/JCDR/2016/17699.7051 -
Translational Medicine @ UniSa Sep 2014In elite athletes, osteitis pubis is a common painful degenerative process of the pubic symphysis and surrounding soft tissues and tendons. We report the diagnostic...
BACKGROUND AND PURPOSE
In elite athletes, osteitis pubis is a common painful degenerative process of the pubic symphysis and surrounding soft tissues and tendons. We report the diagnostic pathway and the rehabilitation protocol of six elite athletes with osteitis pubis in three different sports, and compare protocol stages and time to return to competition.
METHODS
6 athletes (2 soccer, 2 basketball, 2 rugby players) were diagnosed with osteitis pubis stage III and IV according to Rodriguez classification using standard clinical and imaging criteria. After performing a baseline lumbo-pelvic assessment, the rehabilitation protocol described by Verrall was adapted to each individual athlete.
RESULTS
The length of time for each stage of the protocol was as follows; Stage 1 (rest from sport) was 26 +/- 5 days, Stage 2 (to achieve pain free running), 18 +/- 5 days, Stage 3 (squad training) 63 +/- 7, Stage 4 (return to competition) 86 +/- 15. Soccer players took longer to return to competition than basketball and rugby players. No recurrences were reported at 2 year follow-up.
CONCLUSION
The protocol presented ensures a safe return to elite athletes. The time from diagnosis to full recovery is longer in football players, and seems to increase with age.
PubMed: 25147768
DOI: No ID Found -
International Urogynecology Journal Oct 2022Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and... (Observational Study)
Observational Study
OBJECTIVES
Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP.
MATERIALS AND METHODS
We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs.
RESULTS
For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005).
CONCLUSIONS
There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP.
Topics: Diagnosis, Differential; Female; Humans; Imaging, Three-Dimensional; Observer Variation; Pelvic Organ Prolapse; Reproducibility of Results; Ultrasonography; Uterine Prolapse; Valsalva Maneuver
PubMed: 34618192
DOI: 10.1007/s00192-021-04980-y -
Journal of Medical Case Reports May 2009A subpubic cartilaginous cyst is a rare and innocent defect originating from the symphysis pubis and may present as a vulvar mass and/or chronic abdominal pain. The...
INTRODUCTION
A subpubic cartilaginous cyst is a rare and innocent defect originating from the symphysis pubis and may present as a vulvar mass and/or chronic abdominal pain. The symphysis pubis is a non-synovial amphiarthrodial joint that forms a fibrocartilaginous union between the two pubic bones and in general lies without mainstream interest, despite its clinical relevance. This case report focuses attention on this joint.
CASE PRESENTATION
A 55-year-old Caucasian woman presented with a painful and rapidly increasing vulvar mass. Imaging techniques revealed a cyst-like structure originating from a degenerated symphysis pubis. The cyst was excised, however, recovery was complicated by a symphysiolysis.
CONCLUSION
A subpubic cartilaginous cyst is a rare cystic lesion originating from the symphysis of the pubic bone which presents as a vulvar mass which might be complicated by symphysiolysis. Several diseases affect the symphysis pubis and result in significant discomfort and disability in patients. The symphysis pubis is therefore clinically important and should not be omitted in the differential diagnosis of a vulvar mass and/or chronic abdominal pain.
PubMed: 19830169
DOI: 10.1186/1752-1947-3-7294 -
Canadian Journal of Surgery. Journal... Jun 2006Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known. (Comparative Study)
Comparative Study
BACKGROUND
Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known.
METHODS
To determine the success of surgical intervention for osteitis pubis, we used a computerized data registry to identify patients (10 women [mean age 40 yr]) who underwent surgery for osteitis pubis. A retrospective chart review was carried out. We also searched the literature for all cases of osteitis pubis managed surgically and identified 73 cases.
RESULTS
The 10 patients in our series had had symptoms for a mean of 4 years preoperatively. Onset of pain was insidious in 4 patients, it followed childbirth in 4 and it followed trauma in 2. Depending on the surgeon's preference, either a wedge resection of the symphysis pubis was performed or a symphysiodesis. At the latest follow-up (average 26 mo), although all patients had some improvement, only 6 of 10 patients were satisfied with the outcome. From the literature review, we identified 3 categories of patients with osteitis pubis: elite athletes, patients with postoperative or infectious osteitis pubis and the remainder, which would include the patients in our series.
CONCLUSIONS
Four types of surgical intervention are described: curettage, arthrodesis, wedge resection and wide resection. The elite athletes respond well to curettage. Patients with osteitis pubis following urologic or gynecologic procedures or have a proven infection require surgery in roughly 50% of cases. The third group has an unpredictable outcome.
Topics: Adult; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Middle Aged; Orthopedic Procedures; Osteitis; Pubic Bone; Retrospective Studies; Treatment Outcome
PubMed: 16749977
DOI: No ID Found -
International Journal of Surgery Case... Jul 2023Pubic joint enlargement of more than 10 mm is diagnosed and defined as diastasis of the pubic symphysis and is considered a complication of vaginal delivery or...
INTRODUCTION
Pubic joint enlargement of more than 10 mm is diagnosed and defined as diastasis of the pubic symphysis and is considered a complication of vaginal delivery or pregnancy. As it is a rare pathology.
CASE PRESENTATION
We report a patient with severe pelvic pain with impotence of the left IM at day 1 of a dystocic delivery. The clinical examination revealed a sharp pain on palpation of the pubic symphysis. The diagnosis was confirmed by a frontal radiology of the pelvis showing a 30 mm enlargement of the pubic symphysis. The therapeutic management consisted in a preventive unloading and anti-coagulation with an analgesic treatment based on paracetamol and NSAID. The evolution was favorable.
CLINICAL DISCUSSION
The therapeutic management consisted of a discharge and preventive anti-coagulation with an analgesic treatment based on paracetamol and NSAID. The evolution was favorable.
CONCLUSION
The initial early management is medical with the association of oral analgesia, local infiltration, rest and physiotherapy. Pelvic bandaging and surgical treatment are reserved for cases of important diastasis and must be associated with preventive anticoagulation in case of immobilization.
PubMed: 37413756
DOI: 10.1016/j.ijscr.2023.108465 -
Revista Do Colegio Brasileiro de... 2021although locking plates have led to important changes in fracture management, becoming important tools in the orthopedic surgeon's arsenal, the benefits of locking...
PURPOSE
although locking plates have led to important changes in fracture management, becoming important tools in the orthopedic surgeon's arsenal, the benefits of locking plates for traumatic diastasis of the pubic symphysis have not been established. This study was conducted to assess the quality of life in its different domains among patients with traumatic diastasis of the pubic symphysis managed either with locking or nonlocking plate.
METHODS
a prospective cohort study was undertaken at 3 level 1 trauma centres in Brazil. Patients presenting traumatic diastasis of the pubic symphysis treated with plate fixation with a minimum follow-up of 12 months were eligible for inclusion. Through a Pfannenstiel approach, the pubic symphysis was reduced and fixed with a superiorly positioned 4.5mm four to six hole reconstruction locked plate or 3.5mm four to six hole reconstruction nonlocked plate. Posterior injury was managed during the same procedure. Outcome measures were adequate healing of the pelvic injuries, return to pre-injury level on daily activities, and quality of life at the last follow-up visit. Complications and modes of failure were summarized and reviewed. Bivariate linear regression was used to assess individual factors affecting patients' health-related quality of life. A p value of <5% was considered significant.
RESULTS
a total of 31 adult patients (29 males and 2 females) were eligible for the study. Thirteen patients were managed with a reconstruction locked plate and 18 patients with a nonlocked reconstruction plate. Average postoperative follow-up time was 24 months. Adequate healing of the pelvic injuries was achieved in 61.5% of patients treated with locking plates and 94.4% of patients treated with nonlocking plates (p=0.003). Radiographic failure of fixation with minor complications occurred in 46.1% of patients after locked plating versus 11.1% of patients in the nonlocking plate group (p=0.0003). In bivariate analysis, abnormal gait (p=0.007) was associated with a reduced long-term quality of life as measured with the EQ-5D-3L.
CONCLUSION
internal fixation of traumatic diastasis of the pubic symphysis with locking plates has no clinical advantage when compared to nonlocked plating. Mechanical failure and inadequate healing are significantly increased after locked plating of the pubic symphysis. Therefore, we do not recommend routine use of locking plates for managing patients presenting traumatic diastasis of the pubic symphysis.
LEVEL OF EVIDENCE
II (prospective, cohort study).
Topics: Adult; Bone Plates; Cohort Studies; Female; Fracture Fixation, Internal; Humans; Male; Prospective Studies; Quality of Life
PubMed: 34932737
DOI: 10.1590/0100-6991e-20213122 -
Journal of Orthopaedic Surgery and... Jul 2021Diastasis of the pubic symphysis has been reported to occur in 13-16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic...
INTRODUCTION
Diastasis of the pubic symphysis has been reported to occur in 13-16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic symphysis. The aim of this study is to see the width of pubic symphysis relating to age and sex in Koreans.
METHODS
Width of pubic symphysis was measured in pelvis AP and pelvic CT of 784 peoples (392 males, 392 females).
RESULTS
In supine AP, the width at the upper end was 4.8±2.5 mm (males; 3.46±1.38 mm, females; 4.04±2.76 mm). The width at the midpoint was 4.7±2.0 mm (males; 4.64±1.58 mm, females; 4.75±2.29 mm). The width at the lower end was 4.8±2.5 mm (males; 4.58±2.19 mm, females; 5.08±2.76 mm). In abducted AP, the width at the upper end was 3.8±2.9 mm (males; 3.65±1.50 mm, females; 3.97±3.85 mm). The width at the midpoint was 4.6±2.3 mm (males; 4.45±2.16 mm, females; 5.18±3.79 mm). The width at the lower end was 4.8±3.1 mm (males; 4.55±1.30 mm, females; 4.74±3.06 mm). In axial CT, the width at the anterior border was 15.0±6.2 mm (males; 14.50±6.62 mm, females; 16.44±6.22 mm). The width at the narrowest point was 3.1±1.5 mm (males; 3.19±1.53 mm, females; 3.09±1.50 mm). The width at the widest point was 4.1±1.6 mm (males; 4.27±1.60 mm, females; 4.00±1.50 mm). The width at the posterior border was 2.3±1.3 mm (males: 2.20±1.30 mm, females; 2.44±1.40 mm). Axial thickness was 27.1±5.3 mm (males; 29.48±4.60 mm, females; 24.70±4.82 mm). In coronal CT, the width at the upper end was 3.1±4.1 mm (males; 2.28±1.26 mm, females; 3.83±5.48 mm). The width at beginning of widening was 3.6±4.5 mm (males; 2.68±1.63 mm, females; 4.54±6.08 mm). The width at the lower end was 20.5±8.2 mm (males; 17.49±4.53 mm, females; 23.60±9.86 mm). Coronal thickness was 20.4±7.1 mm (males; 24.50±5.98 mm, females; 16.23±5.61 mm). In supine film, width significantly increased with age at the upper end (p=0.022) and midpoint (p< 0.001); however, it decreased at the lower end (p< 0.001). In abduction film, width at midpoint increased with age (p=0.003).
CONCLUSION
Pelvic malunion should be defined according to the population and age. These results could be a reference in assessing the quality of reduction after internal fixation of the patients with traumatic diastasis of the pubic symphysis.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Pelvimetry; Pubic Symphysis; Radiography; Reference Values; Republic of Korea; Retrospective Studies; Sex Factors; Young Adult
PubMed: 34217332
DOI: 10.1186/s13018-021-02561-9