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Osteitis Pubis M85.30 733.5

osteitic pubis xray

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

 

Osteitis Pubis ICD-10

Osteitis Pubis ICD-9

  • 733.5 Osteitis condensans (piriform sclerosis of ilium)

Osteitis Pubis Etiology / Epidemiology / Natural History

  • Typically not infections inflammation of the pubis symphysis
  • synonyms: pubic symphysis, symphysis pubis, or symphysis pubica
  • May occur after invasive pelvic procedures, pregnancy/childbirth, trauma
  • May occur in certain sports: dance, ballet, running, rugby, hockey, tennis, football, soccer.
  • Generally occurs in patients 30-50 yrs old. 

Osteitis Pubis Anatomy

  • May be associated with inflammaiton of the adductor longus

Osteitis Pubis Clinical Evaluation

  • Complain of hip, pelvic and groin pain.
  • Tenderness of symphysis pubis.
  • Increased pain with rectus abdominus testing and bilateral compression of the greater trochanters.
  • May have waddling gait.

Osteitis Pubis Xray / Diagnositc Tests

  • Plain films of the pelvis may demonstrate sclerosis, lysis and widening of the pubic symphysis
  • MRI: inflammatory signal changes in the pubic symphysis +/- bone marrow edema.

Osteitis Pubis Classification / Treatment

  • Rest, NSAIDs, directed physical therapy, with gradual return to sports when symptoms subside.
  • May require cane/crutches.  Consider sacroiliac belt.
  • Consider steriod injection into the pubic symphysis (Holt mA, AJSM 1995;5:601)
  • Surgical options: (rarely indicated) curettage, arthrodesis, wedge resection.

Osteitis Pubis Associated Injuries / Differential Diagnosis

Osteitis Pubis Complications

  • Continued pain
  • Pelvic instability
  • Weakness

Osteitis Pubis Follow-up Care

  • Athletes generally should refrain from sports until symptoms completely resolve and they have completed a graduated return to sport exercise program.  This often takes 3-6 months.
  • Average time to recovery is 7-10 months.
  • Recurrence is common

Osteitis Pubis Review References

  • Williams PR, AJSM 2000;28:350
  • Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. Sep 30 2008
  • Mehin R, Meek R, O'Brien P, et al. Surgery for osteitis pubis. Can J Surg. Jun 2006;49(3):170-6.
  • Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. Jan 2008;36(1):122-8.
  • Andrews SK, Carek PJ. Osteitis pubis: a diagnosis for the family physician. J Am Board Fam Pract. Jul-Aug 1998;11(4):291-5.

 

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