Osteitis Pubis


  • Osteitis pubis is a pubic bone stress injury with inflammation of the symphysis pubis. It produces symphyseal inflammation, periarticular bone sclerotic changes, and groin and pubic pain that can be severe.
  • It may result from infection or sterile inflammation.
  • The current mechanical etiology is unknown but it is thought to be the result of repetative stress of the muscles that attach near the symphysis pubis, including the rectus abdominus, gracilis, and adductor longus.
  • It has been reported to occur after athletic overuse, childbirth, pelvic surgery, and trauma (Lentz 1995).
  • Potential risk factors include limited hip ROM, weak hip adductors or abductors, and training errors. Training errors include a sudden increase in training intensity, duration, or frequency.
  • Preseason training has shown to be protective against development of this condition (Lovell 2006).
  • Incidence in athletes has been reported to be between .5 and 7% (Rodriguez 2001)

Clinical Presentation and Diagnosis

  • The patient complains of pain in the groin or medial thigh. This may be accompanied by adductor or abdominal muscle spasm
  • Differential diagnosis includes adductor muscle strain, sportsman's hernia, iliopsoas bursitis, and muscular avulsion
  • There is a possible loss of IR or ER passive hip ROM
  • Tenderness over the pubis
  • Pain with resisted bilateral hip adduction
  • Radiographs will show loss of definition of bony margins with widening of the symphysis pubis. In chronic cases it may appear "moth eaten". Occasionally, there may be more than 2mm cephalad translation of one of the superior pubic rami and Symphyseal cleft widening of more than 10mm (Fricker 1991; Rodriguez 2001). There may be mild to severe bilateral subchondral irregularity with focal areas of demineralization. Subchondral cysts and erosions may be identified as well.
  • Parasymphyseal bone marrow edema evident on T2 MRI (Holmich 2004)
  • Bone scans are hot over the pubic symphysis
  • Presents similar to symphyseal instability
  • Symphyseal injection will decrease the pain and aid in diagnosis


  • Rest
  • NSAIDs
  • Physical Therapy
  • Corticosteroid injections
    • A study performed in athletes demonstrated 87.5% improvement after symphysial steroid and anesthetic injection (O'Connell 2002).
  • Prolotherapy
    • Topol (2005) reported good results with prolotherapy in rugby and soccer players suffering from chronic groin pain.
  • Surgery includes:
    • Wedge resection of the pubic symphysis, which carries risk of progressive sacroiliac arthrosis and posterior pelvic instability. (Grace 1989)
    • Complete resection of the joint
    • Arthrodesis of the symphysis pubis, which involves autogenous bone grafting and plate fixation, and carries risk of nonunion. (Williams 2000)
    • Curettage of the symphysis (Mulhall 2002)
Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License