yoga book / pathology / osteitis pubis

Definition

In contrast to symphysitis, osteitis pubis or pubalgia is a disease of the pubic bone and subordinate neighbouring tissues. Pubalgia is the term used in the first description by Spinelli in 1932, which is still widely used in English-speaking countries today. Local inflammation and repair processes, in which granulation tissue is injected into the bone, can lead to bone cysts, osteolysis and other stress reactions. Haemorrhage into the bone can also occur as part of birth-related symphysis detachment, but this has not yet been proven in athletes. The most important aetiological factors are instability of the ISG, limited hip flexibility, repeated high shear forces in the pelvic ring, soccer ridge and overuse with microtrauma in various sports, especially running and football. Over the decades, this disorder has been described for various sports, including rugby, tennis, American football and basketball, but the highest incidence is seen in football. In a sample of over 800 sports students, 1.7% suffered from it, with a male to female ratio of 5:1.

The pain can radiate towards the adductor muscles or the rectus abdominis, and both strain and stretching can trigger the pain. Clinically, there is pressure pain over the symphysis, the adductor muscles can be pressure pain and strain pain. The tenderness of the adductors painfully restricts abduction. It is not uncommon for clinical testing to be conspicuous on only one side. In addition to the specific pain radiating to the muscles mentioned, pain radiating to the hip, groin or testicles is described.

Relevant differential diagnoses include inguinal hernias, stress fractures of the pubic bone and the sitz bone, avulsion fractures and football groin, osteomyelitis, prostatitis, orchitis and urolithiasis. The possibility of secondary occurrence in Morbus Bechterew, RA and Morbus Reiter should be considered. X-rays only show the changes in the bone after the disorder has been present for some time, MRI and CT earlier and better. Diagnosis is often delayed. Therapeutically, it is important to suspend the triggering stresses, i.e. sports with sprints, stop and go and other stresses on the adductors or the hip and pelvic muscles in general. The recommendations vary from a two-week break from sport to permanent cessation of the triggering sport. Stretching overstretched adductors is of great importance. NSAIDs and infiltration therapy are possible and should be considered if there is no improvement after two weeks of abstinence from sport. There are hardly any evaluated surgical treatment options.

Cause

1. Overuse
2. rare: traumatic

Predisposing

1. inflexible, hypertone Adduktoren
2. Muscular imbalances in the hip and pelvic muscles
3. Instabilität der ISG
4. Fußballerleiste
5. Sportarten mit häufigem Start-Stopp oder Richtungswechseln
6. Innenfuß-Schußtechnik beim Fußball

Diagnose

1. MRT, CT

Symtome

1. Pain radiating towards the adductor muscles or the rectus abdominis
2. Pressure tenderness over the symphysis
3. pressure-painful and strain-painful adductor muscles
4. Painfully restricted abduction

Complications

Therapie

1. Avoid triggering stresses, especially high forces and rapid movements of the adductors
2. Stretching training for the adductor muscles

DD

1. Inguinal hernias
2. Stress fractures of the pubic bone and the sitz bone
3. Avulsion fractures
4. Football bar
5. Osteomyelitis
6. Prostatitis
7. Orchitis
8. Urolithiasis

External sources