Osteitis pubis (OP) is characterized by non-infectious inflammation of the pubic symphysis.
The presentation is typical with varying degrees of pelvic and/or perineal pain, reproduced on hip adduction.
Although the etiology is sometimes unknown, the most common causes are:
- pregnancy/childbirth 2
- high-level of athletic activity: see athletic pubalgia
- urological or gynecological surgery 2
- psoriatic arthritis
- ankylosing spondylitis
Plain radiograph and CT
The x-ray and CT findings are subchondral erosive change, joint irregularity and sclerosis, which may eventually lead to ankylosis. Positive findings usually are not apparent until 4 weeks after the onset of symptoms
MRI may demonstrate parasymphyseal bone marrow edema although this finding may also be seen in asymptomatic individuals. Symphyseal fluid and peripubic soft-tissue edema during initial stages may also be seen 1.
Subchondral sclerosis, subchondral resorption and bony margin irregularities, and osteophytes may be seen with the chronicity of disease 4.
Bone scans may be negative but can demonstrate intense signal uptake at the pubic symphysis.
Treatment and prognosis
Treatment is symptomatic and mainly relies upon rest. Symphyseal cleft injections can be performed for diagnostic and therapeutic measures, gaining short-term symptom relief in small case series 6.
The main differential diagnoses are infection (osteomyelitis pubis 8) and hyperparathyroidism, the latter due to bone resorption. On MRI, the initial stages of osteitis pubis may mimic osteomyelitis 1.
- 1. Gibbon WW, Hession PR. Diseases of the pubis and pubic symphysis: MR imaging appearances. AJR Am J Roentgenol. 1997;169 (3): 849-53. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Lentz SS. Osteitis pubis: a review. Obstet Gynecol Surv. 1995;50 (4): 310-5. Obstet Gynecol Surv (link) - Pubmed citation
- 3. Zoga AC, Kavanagh EC, Omar IM et-al. Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 2008;247 (3): 797-807. doi:10.1148/radiol.2473070049 - Pubmed citation
- 4. Kunduracioglu B, Yilmaz C, Yorubulut M et-al. Magnetic resonance findings of osteitis pubis. J Magn Reson Imaging. 2007;25 (3): 535-9. doi:10.1002/jmri.20818 - Pubmed citation
- 5. Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR. American journal of roentgenology. 191 (4): 962-72. doi:10.2214/AJR.07.3410 - Pubmed
- 6. Via AG, Frizziero A, Finotti P, Oliva F, Randelli F, Maffulli N. Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature. (2019) Open access journal of sports medicine. 10: 1-10. doi:10.2147/OAJSM.S155077 - Pubmed
- 7. Becker I, Woodley SJ, Stringer MD. The adult human pubic symphysis: a systematic review. (2010) Journal of anatomy. 217 (5): 475-87. doi:10.1111/j.1469-7580.2010.01300.x - Pubmed
- 8. Yax J, Cheng D. Osteomyelitis pubis: a rare and elusive diagnosis. (2014) The western journal of emergency medicine. 15 (7): 880-2. doi:10.5811/westjem.2014.8.13401 - Pubmed
- 9. Gaudino F, Spira D, Bangert Y, Ott H, Beomonte Zobel B, Kauczor HU, Weber MA. Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. (2017) European journal of radiology. 94: 46-52. doi:10.1016/j.ejrad.2017.07.009 - Pubmed