Symthesis Pubis Disorder
Is there anyone out there who has heard of this problem.
I have had the above problem now for a bout a year. It started when I was five months pregnant and I was in severe pain and in hospital for weeks. So far nobody has any real idea of how to treat the problem . I have now had my baby and have seen a osteopath , a physio, and now I have been referred to a Reumotologist. The pain is very bad in my pelvis and lower back, at present I am taking codeine phosphate and paretomol mixed, I have had pethodene and morphine for the pain, while in hospital. I have had blood tests which show nothing wrong, also x-rays which show no damage. Is there anyone who has had this to this severity, if so please let me know what kind of treatment you recommend
I had not heard of this syndrome before but find that there is quite a lot of medical literature on the subject. Symphysis osteitis is supposed to be self-limiting inflammatory condition. Unfortunately, there is not much discussion of treatments. I don't know whether it would be helpful but I attach some abstracts.
• Allsop JR (1997). Symphysis pubis dysfunction. Br J Gen Pract. 47 (417): 256. Summary: <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=9196977>
• Andrews SK and Carek PJ (1998). Osteitis pubis: a diagnosis for the family physician. J Am Board Fam Pract. 11 (4): 291-5. Summary: BACKGROUND: Osteitis pubis was first described in 1924 in patients who had had suprapubic surgery. Since that time many theories concerning the cause of the disease have been developed. Published case reports and retrospective record reviews of specific, isolated patient populations have been used to postulate an infectious, inflammatory, or traumatic cause of this condition. Such confusion reduces the likelihood of an accurate diagnosis of osteitis pubis, particularly in the primary care setting, where it is becoming increasingly likely that patients afflicted with this frustrating illness will initially seek treatment. METHODS: This article describes a case report and provides a review of the literature. The medical literature was searched using the following key words: "abdominal pain," "pelvic pain," "inflammation," "symphysis pubis," and "enthesopathy." RESULTS AND CONCLUSIONS: Osteitis pubis, considered to be the most common inflammatory disease of the pubic symphysis, is a self-limiting inflammation secondary to trauma, pelvic surgery, childbirth, or overuse, and it can be found in almost any patient population. Occurring more commonly in men during their 30s and 40s, osteitis pubis causes pain in the pubic area, one or both groins, and in the lower rectus abdominis muscle. The pain can be exacerbated by exercise or specific movements, such as running, kicking, or pivoting on one leg, and is relieved with rest. Pain can occur with walking and can be in one or several of many distributions: perineal, testicular, suprapubic, inguinal, and postejaculatory in the scrotum and perineum. Symptoms are described as "groin burning," with discomfort while climbing stairs, coughing, or sneezing. A greater understanding and awareness of osteitis pubis will reduce patient and physician frustration while improving overall outcomes. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=9719351> Department of Family Medicine, Medical University of South Carolina, Charleston, USA.
• Dhar S and Anderton JM (1992). Rupture of the symphysis pubis during labor. Clin Orthop. (283): 252-7. Summary: Two cases of spontaneous rupture of the symphysis pubis (SP) during delivery are reported. The separations were associated with considerable pain, swelling, and tenderness over the symphysis pubis and were confirmed roentgenographically. Both patients were treated conservatively with bed rest, mostly in the lateral decubitus position, within pelvic binders. Immobilization was discontinued when they were pain free. The SP separations remained in reduced positions. The patients were essentially asymptomatic and walked normally. Conservative treatment followed by early mobilization is adequate treatment for SP separations. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=1395254> Countess of Chester Hospital, England.
• Eskridge C, Longo S, Kwark J, Robichaux A and Begneaud W (1997). Osteomyelitis pubis occurring after spontaneous vaginal delivery: a case presentation. J Perinatol. 17 (4): 321-4. Summary: BACKGROUND: Osteomyelitis pubis is an uncommon disorder. The clinical presentation is similar to that of osteitis pubis, which is a self-limiting condition. However, osteomyelitis pubis necessitates intensive intravenous antibiotic therapy and, frequently, surgery to effect a cure. CASE: A 33-year-old gravida II para 1001, Filipina vaginally delivered a 3802 gm baby on April 5, 1994. The delivery was complicated by shoulder dystocia. Her postpartum course was complicated by an abscessed tooth and pubic pain that was exacerbated by ambulation. On the twentieth postpartum day, she came to the emergency department with massive cellulitis of the mons veneris and labia majora. The results of an x-ray examination and bone scan were consistent with osteomyelitis of the pubis. The patient did not respond to multiple intravenous antibiotics, and surgical debridement was required. CONCLUSIONS: A diagnosis of osteomyelitis pubis should be considered for any patient who experiences pubic pain that is exacerbated by walking. Proper therapy consists of intravenous antibiotics and surgical debridement, as necessary, in patients who do not respond to antibiotics. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=9280101> Department of Obstetrics and Gynecology, Leonard J. Chabert Medical Center, Houma, LA, USA.
• Fricker PA, Taunton JE and Ammann W (1991). Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med. 12 (4): 266-79. Summary: Medical records of 59 patients (9 females and 50 males), who presented to sports medicine clinics at the Australian Institute of Sport and the University of British Columbia between 1985 and 1990 and who were diagnosed as suffering osteitis pubis, were reviewed and comparison of data obtained was made with the literature. Women average 35.5 years of age (30 to 59 years) and men 30.3 years (13 to 61 years). Sports most frequently involved were running, soccer, ice hockey and tennis. Clinical presentations of osteitis pubis fell into 4 main groups. 'Mechanical' (sport-related) was the largest group (n = 48), followed by 'obstetric' (n = 5), 'inflammatory' (n = 4) and 'other' (n = 2). Period of follow-up averaged 10.3 months (1 to 20 months) in women and 17.5 months (2 to 96 months) in men. Full recovery, when documented, averaged 9.5 months in men and 7.0 months in women. Osteitis pubis recurred in 25% of these men and none of these women at follow-up. The most frequent symptoms were pubic pain and adductor pain. Men also presented with lower abdominal, hip and perineal or scrotal pain; women with hip pain. Most common signs were tenderness of the pubic symphysis and tenderness of adductor longus muscle origin. Men also revealed tenderness of one or both the superior pubic rami and evidence of decreased hip rotation (unilateral or bilateral). Evidence of pelvic malalignment and/or sacroiliac dysfunction was frequently seen in both men and women. There was poor correlation between radiographic and isotope bone scan findings and the site and duration of symptoms and signs. Femoral head ratios were estimated on 30 hips in the series and 2 were judged to be at the upper limit of normal, perhaps indicating a form of epiphysiolysis producing tilt deformity of the head of the femur. It is clear that osteitis pubis in athletes is not uncommon and that factors such as loss of rotation of hips and previous obstetric history are important in the aetiology and management of this condition. Pelvic infection, which was believed to be the primary factor of osteitis pubis in the literature up until the 1970s, plays a very small role in this condition in athletes. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=1784877> Department of Sports Medicine, Australian Institute of Sport, Canberra.
• Gonik B and Stringer CA (1985). Postpartum osteitis pubis. South Med J. 78 (2): 213-4. Summary: We have presented a rarely described case of osteitis pubis occurring in a postpartum period. This rapidly progressive, nonsuppurative osteonecrosis of the symphysis pubis is frequently confused with other entities. Because the prognosis for recovery is invariably good, acute intervention is directed at relieving pain by immobility and anti-inflammatory agents. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=3975721>
• Guis-Sabatier S, Pieri-Balandraud N, Garnier-Soumet P, Coste J, Roux H and Mattei JP (1999). Pubic pain in athletes: a case due to an abscess in the obturator muscle. Rev Rhum Engl Ed. 66 (1): 58-60. Summary: Pubic pain is a common symptom in soccer players. Its cause can be difficult to determine. We report a case in a 19-year-old soccer player who had an abscess in the obturator internus muscle. We are aware of only one similar report in the literature. Painful limitation of internal rotation of the hip and evidence of infection suggested the diagnosis, which was confirmed by magnetic resonance imaging. In a soccer player, a fever and groin pain do not always indicate osteitis pubis. Limitation of internal rotation of the hip should suggest a lesion in the obturator internus muscle. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=10036702> Department of Rheumatology, Conception Teaching Hospital, Marseille, France.
• Heath T and Gherman RB (1999). Symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy associated with McRoberts' maneuver. A case report. J Reprod Med. 44 (10): 902-4. Summary: BACKGROUND: McRoberts' maneuver is often used prophylactically with the onset of active maternal expulsive efforts or immediately before delivery of the fetus. CASE: A 31-year-old woman, gravida 1, para 0, at 39 + 2 weeks' gestational age, was continuously maintained in an exaggerated lithotomy position while actively pushing during the second stage of labor. Immediately following spontaneous vaginal delivery of a 3,598-g infant, the patient noted left gluteal pain and left anterior thigh dysesthesia. Orthopedic evaluation revealed a 5-cm symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy. The patient underwent closed reduction of the left hemipelvis, followed by open reduction and internal fixation of the symphysis pubis two weeks later after failing conservative treatment. CONCLUSION: Although McRoberts' maneuver is generally safe, care should be exercised with use of excessive force or prolonged placement of the patient's legs in a hyperflexed position. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=10554757> Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Virginia, USA.
• Karpos PA, Spindler KP, Pierce MA and Shull HJ, Jr. (1995). Osteomyelitis of the pubic symphysis in athletes: a case report and literature review. Med Sci Sports Exerc. 27 (4): 473-9. Summary: Groin pain is a common problem in athletes. Osteitis pubis, a chronic inflammatory condition involving the pubic symphysis, is a rare cause, and pyogenic osteomyelitis of the pubis is seen even more rarely in healthy athletes. We report one of four cases of pyogenic osteomyelitis of the pubis seen at our institution, review our experience with all four cases, and present a review of the literature (7 cases). The diagnosis is established by the presence of extreme pain, point tenderness at the pubic symphysis, fever, and either a positive culture of blood, needle aspiration, or open biopsy of the pubis. White blood cell count, erythrocyte sedimentation rate, and the results of bone scan and computerized tomography may initially be normal and therefore cannot exclude the diagnosis. Prompt treatment with intravenous (i.v.) antibiotics effective against Staphylococcus aureus (causative organism in all documented cases-9/11) should initially be administered and then guided by culture and sensitivity information. Oral antibiotics should be given if the infection is responsive to i.v. antibiotic treatment. Prompt recognition and treatment with antibiotics may obviate the need for surgical debridement. All athletes who returned to sports activity did so by 6 months after diagnosis. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=7791575> Department of Orthopaedics and Rehabilitation, and Internal Medicine, Vanderbilt University Medicine Center, Nashville, TN 37232, USA.
• Kharrazi FD, Rodgers WB, Kennedy JG and Lhowe DW (1997). Parturition-induced pelvic dislocation: a report of four cases. J Orthop Trauma. 11 (4): 277-81; discussion 281-2. Summary: OBJECTIVE: To describe our experience with four cases of severe pelvic dislocation associated with difficult parturition. DESIGN: Retrospective case series. PATIENTS: Four patients, each with rupture of the symphysis pubis and sacroiliac joints during labor. All injuries were associated with significant initial pain and disability. All developed persistent symptoms related to the sacroiliac disruption. INTERVENTIONS: The three patients who had presented acutely were freated with closed reduction and application of a pelvic binder. Two underwent closed reduction of their pelvic dislocation while anesthetized with a general anesthetic. One patient (N.A.), who presented late, had not been treated with a binder. RESULTS: All four patients had persistent posterior pelvic (sacroiliac) pain. In two patients a postpartum neuropathy persisted. CONCLUSIONS: Severe pelvic dislocations are rare during labor, with conservative treatment reported to be successful in most cases. The persistence of symptoms in our patients emphasizes the need for careful examination and follow-up of these rare injuries. Because the outcome in our patients was poor and results in the literature are equivocal, we suggest the consideration of an operative approach to treatment in patients with symphyseal diastasis of > 4.0 cm. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=9258826> Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
• Mader R and Yeromenco E (1999). Pseudomonas osteomyelitis of the symphysis pubis after inguinal hernia repair. Clin Rheumatol. 18 (2): 167-9. Summary: Osteitis pubis (OP) is a term used to describe an entity characterised by severe pelvic pain, a wide-based gait and bony destruction of the margins of the pubic symphysis. It is usually assumed that OP is a non-infectious, self-limiting, relatively benign condition. Infectious osteomyelitis of the symphysis pubis (IOSP) is very unusual and the clinical presentation can resemble OP. IOSP following inguinal hernia repair is extremely rare. A case of IOSP caused by Pseudomonas aeruginosa is described. We reiterate the assumption that IOSP can be misdiagnosed as OP. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=10357126> Department of Medicine A, Emek Medical Center, Afula, Israel.
• Major NM and Helms CA (1997). Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in athletes. Skeletal Radiol. 26 (12): 711-7. Summary: OBJECTIVE: To demonstrate with radiographic imaging the association between pubic stress injury and sacroiliac abnormalities in athletes. DESIGN AND PATIENTS: Eleven athletes (9 men and 2 women), comprising seven male long-distance runners, one male soccer player, one male and two female basketball players, were imaged with plain films for complaints of pubic symphysis pain, sciatica, groin pain, or a combination of these complaints. In addition to the plain films, four patients were imaged with CT, two patients had MR imaging, and a bone scan was performed in three patients. Anteroposterior plain films of the pelvis of 20 patients without back pain or pubic pain were evaluated for comparison as a control group (ages 18-72 years, average 49 years; 11 women and 9 men). RESULTS: All athletes showed plain film evidence of either sclerosis, erosions or offset at the pubic symphysis. Four had avulsion of cortical bone at the site of insertion of the gracilis tendon. Four patients demonstrated sacroiliac joint abnormalities on plain films consisting of sclerosis, erosions and osteophytes, and in one of these athletes, bilateral sacroiliac changes are present. Two patients with normal sacroiliac joints on plain films had a bone scan showing increased radionuclide uptake bilaterally at the sacroiliac joints. One patient with both plain film and CT evidence of sacroiliac abnormalities had an MR examination showing abnormal signal at both sacroiliac joints and at the pubic symphysis. A sacral stress fracture was found on CT in one patient with complaints of sciatica. In the control group, six patients, all over the age of 55 years, had mild sclerosis of the symphysis, but no plain film evidence of sacroiliac abnormalities. CONCLUSION: We have found a group of athletes in whom stress injuries to the pubic symphysis are associated with changes in the sacroiliac joint as demonstrated by degenerative changes or in the sacrum as manifested as a sacral stress fracture. These findings are probably due to abnormal stresses across the pelvic ring structure that lead to a second abnormality in the pelvic ring. The abnormality in the sacrum is not always well seen with conventional imaging. Recognition of the association of stress injury of the symphysis with back pain is important in that it can help avoid inappropriate studies and diagnostic confusion. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=9453104> Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
• Mens JM (2001). [Pain in the symphyseal region after parturition; possibly osteomyelitis]. Ned Tijdschr Geneeskd. 145 (29): 1431. Summary: <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=11494701>
• Musumeci R and Villa E (1994). Symphysis pubis separation during vaginal delivery with epidural anesthesia. Case report. Reg Anesth. 19 (4): 289-91. Summary: BACKGROUND AND OBJECTIVES. Peripartum pubic separation (diastasis pubis) is an uncommon event with a reported incidence varying between one in 521 to one in 30,000 deliveries. The injury is caused by the fetal head exerting pressure on pelvic ligaments that have been weakened or relaxed by the hormones progesterone and relaxin. Diastasis pubis has been previously reported in both obstetric and orthopedic literature. However, the authors have been unable to locate any discussion of this condition in the anesthetic literature. Historically, symphyseal separation has been frequently unrecognized. The authors present the case of a nulliparous woman who suffered a diastasis pubis during assisted vaginal delivery under epidural anesthesia. METHODS. Epidural catheter placement and administration of medications were performed using standard techniques described. RESULTS. The patient had an episode of breakthrough pain during labor despite adequate epidural analgesia and experienced postoperative pubic and thigh pain secondary to pubic separation. CONCLUSIONS. Diastasis pubis is an uncommon injury that should be considered when evaluating patients in the peripartum period who are experiencing suprapubic, sacroiliac, or thigh pain. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=7947431> Department of Anesthesia and Critical Care, Beth Israel Hospital, Springfield, Massachusetts.
• Nilsson-Wikmar L, Harms-Ringdahl K, Pilo C and Pahlback M (1999). Back pain in women post-partum is not a unitary concept. Physiother Res Int. 4 (3): 201-13. Summary: BACKGROUND AND PURPOSE: At least half of all pregnant women experience back pain at some time during pregnancy and some of them also have persisting back pain post-partum. The aim of the present study was to identify and classify back problems in women post-partum by use of different pain provocation tests and define their relationship to spinal sagittal configuration and mobility. METHOD: One hundred and nineteen women with back pain persisting two months after delivery were interviewed and examined, on average 7.2 months post-partum. Ten clinical pain provocation tests were performed. The first was performed to identify hip pain, the second to identify radiating pain and the other eight tests were performed to provoke pain in the areas of the posterior pelvic/sacroiliac joints, the symphysis pubis and the lumbar spine. The spinal sagittal configuration and mobility were measured in the thoracic and lumbar spine, respectively, with Debrunner's kyphometer (Protek AG, Berne, Switzerland). RESULTS: Twenty-seven per cent of women had pain in the area of the posterior pelvic/sacroiliac joints, 18% in the area of the lumbar spine, 39% both in the area of the posterior pelvic/sacroiliac joints and in the lumbar spine, and in 16% no pain could be provoked. There were no statistically significant differences between the four groups with respect to the spinal sagittal configuration or the mobility in the thoracic or lumbar spine. CONCLUSIONS: Back pain post-partum is not a unitary concept. Based on the clinical tests, women with back pain post-partum can be separated into groups with different pain localizations. The measuring of the spinal sagittal configuration and mobility did not help to further identify or classify post-partum back pain. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=10581626> Department of Physical Therapy, Karolinska Institutet, Stockholm, Sweden. email@example.com
• Schoellner C, Szoke N and Siegburg K (2001). [In Process Citation]. Z Orthop Ihre Grenzgeb. 139 (5): 458-62. Summary: AIM: Is the sonographic measurement of the symphysis pubis enough to enable a prognosis of the occurrence of symphyseal pain during pregnancy and birth? METHOD: First of all, a simplified definition of symphyseal pain was categorized in order to make the classification more easy. The symphyseal widths of 171 pregnant women were measured during pregnancy and after birth. Our control group consisted of 25 non-pregnant women. 15 of the 171 patients suffered from symphyseal pain; however, 156 of the 171 did not. Additionally, we measured the intrapartal symphyseal width in 11 of the women. RESULTS: The average symphyseal width of non-pregnant women was 4.07 mm (s = 0.79; n = 25). Pre- and postpartally we measured 6.32 mm (s = 1.71; variation of 3 to 16 mm) in pregnant asymptomatic women. A significant increase in width was recorded in the 15 women with pain in the symphysis: the symphyseal width was 10.62 mm (s = 2.37; Variation from 6.7 to 15.25 mm). Intrapartally the symphyseal width varied between 5.8 and 1.2 mm. CONCLUSION: Ultrasound measurement of the symphyseal width shows around 4 mm in non-pregnant women. Asymptomatic pregnant women have an average width of 6.3 mm. The majority of pregnant women with 9.5 mm or more have symphyseal pain. If that is the case then conservative treatment is usually sufficient to cure this complaint. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=11605300> Orthopadische Universitats- und Poliklinik Mainz. schoelln@mail.Uni-Mainz.de
• Senechal PK (1994). Symphysis pubis separation during childbirth. J Am Board Fam Pract. 7 (2): 141-4. Summary: A severe case of separation of the symphysis pubis during labor and delivery is reported, which included severe pain and unusual complications of urinary outflow incontinence and fecal incontinence that gradually resolved with conservative treatment. The incidence of symphysis pubis separation is reported to be between 1:600 and 1:3400 obstetric patients. Treatment should generally be conservative and symptomatic. Prognosis for recovery is excellent. Recurrent separation of the symphysis pubis could occur during subsequent deliveries but generally is no worse than the first occurrence. This case report illustrates the unusual complications that can occur with severe diastasis of the symphysis pubis during pregnancy. Family physicians, obstetricians, and orthopedic surgeons could encounter this complication of childbirth in their own practices. Although the symptoms are dramatically severe in presentation, a conservative management approach is effective. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=8184705> Department of Family Practice, 646th Medical Group, Eglin AFB, Florida 32542-1281.
• Seve P, Boibieux A, Pariset C, Clouet PL, Bouhour D, Tigaud S, Biron F, Chidiac C and Peyramond D (2001). [Pubic osteomyelitis in athletes]. Rev Med Interne. 22 (6): 576-81. Summary: INTRODUCTION: Pubic osteomyelitis has been described in three situations: children in whom Staphylococcus aureus is the preeminent pathogen; elderly patients who have undergone genitourinary procedures, and parenteral drug abusers. In contrast, pubic osteomyelitis in athletes has been described less often. We report three cases of acute staphylococcal pubic osteomyelitis in young athletic men and present a review of the literature. EXEGESIS: The clinical presentation in each case was acute groin, hip, or perineal pain; fever; inability to bear weight; and pubic symphysis tenderness. The diagnosis was established by blood culture and radiologic changes. CONCLUSIONS: Staphylococcus aureus pubic osteomyelitis should be suspected in athletes who have febrile hip or groin pain. The pathogenesis of this disease is thought to involve preexisting trauma or athletic injury and subsequent seeding of this area during transient bacteremia. Prolonged antimicrobial therapy is required for the cure, and debridement with curettage may be necessary if patients have persistent infection or sequestra. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=11433568> Service des maladies infectieuses, hopital de la Croix-Rousse, 69004 Lyon, France.
• Sexton DJ, Heskestad L, Lambeth WR, McCallum R, Levin LS and Corey GR (1993). Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review. Clin Infect Dis. 17 (4): 695-700. Summary: Osteitis pubis is a painful inflammatory process resulting in bony destruction of the margins of the symphysis pubis. Despite six decades of speculation, the pathogenesis of, criteria for diagnosis of, natural history of, and optimal therapy for osteitis pubis remain controversial. We present four cases of postoperative pubic osteomyelitis that were initially thought to be typical cases of osteitis pubis. These cases illustrate that pubic osteomyelitis can mimic the principal features of osteitis pubis including characteristic pelvic pain and gait disturbance, symmetrical bony destruction of the symphysis pubis, absence of fever, a long interval between surgery and onset of symptoms, lack of response to antimicrobial therapy, and apparent spontaneous cure. We believe that many previously reported cases of osteitis pubis were actually cases of unrecognized pubic osteomyelitis. We advise an aggressive diagnostic approach to cases of apparent postoperative osteitis pubis including biopsy and needle aspiration of the symphysis pubis guided by computer-assisted tomography. If cultures of biopsy specimens are not diagnostic, open biopsy of the symphysis pubis is recommended. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=8268352> Divisions of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710.
• Shepherd J and Fry D (1996). Symphysis pubis pain. Midwives. 109 (1302): 199-201. Summary: <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=8718241>
• Spaeth DG (1997). Observatory clues to aid in the diagnosing of diastasis symphysis pubis: an underreported complication of parturition. J Am Osteopath Assoc. 97 (3): 152-5. Summary: Diagnosis of diastasis symphysis pubis in the postpartum period need not depend on radiographic findings. This diagnosis can be made with simple observation techniques. Entertaining a high index of suspicion and observation of the patient are the most important contributions the physician can make. Parameters triggering a tentative diagnosis would include, but not be limited to, a large infant, a small pelvis, a rapid second stage of delivery, or application of forces to abduct the thighs. The diagnosis of diastasis symphysis pubis should be ruled out if the following conditions are present postpartum: the flattened abdomen (the postpartum "pooch" is absent); the patient is incontinent of urine when changing position from supine/prone to upright; the patient has pain in the hips or sacral region when walking; or the patient waddles when walking. The change in gait, or the pain on walking may not be noticed until 24 hours or more after delivery. However, the change in abdominal contour and incontinence is noticed immediately. Using these observational clues, the physician can institute treatment sooner, thereby expediting recovery. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=9107125> Department of Family Medicine, Ohio University College of Osteopathic Medicine, Athens 45701, USA.
• Vincent C (1993). Osteitis pubis. J Am Board Fam Pract. 6 (5): 492-6. Summary: BACKGROUND: A 55-year-old woman was seen for pubic symphysis tenderness that started 3 weeks after bladder suspension surgery for urinary incontinence. A diagnosis of osteitis pubis was made based on the results of the physical, radiographic, and laboratory examinations. The paucity of information on this topic in primary care textbooks prompted a literature review of the subject. METHODS: A computer-assisted literature search of the MEDLINE files from 1966 to the present was performed using the terms "osteitis," "osteomyelitis," and "pubic symphysis." Older documents and papers of related interest were obtained by cross-reference of the bibliographies of the articles generated by the search. RESULTS AND CONCLUSIONS: Osteitis pubis is an infrequent complication of pelvic surgery, parturition, or athletic activities. The diagnosis is made on the basis of the typical findings of pubic tenderness and pain on hip abduction that occurs a few weeks following the inciting event. Initial treatment consists of rest, physical therapy, and oral nonsteroidal or glucocorticoid anti-inflammatory medications. The use of intra-articular glucocorticoid injections is controversial. Surgery is rarely indicated and should be reserved for patients who have severe pain or pubic instability that has not responded to conservative therapy. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=8305019> Swedish Hospital Family Practice Residency, Seattle, Washington 98104.
symtheis pubis disfunction
Thank you very much for the literature you have enclosed, this conditions happens to about 1 in 800 people in the Uk and there is not much you can find out on the subject.
I am seeing a Reumotologist on the 12 December so I will let you know what the consultant thinks of my case.
Many thanks again
Symthesis Pubis Disorder
Thank you very much for your information.
I have had the MRI scan which showed nothing, I was also put on Amitrpytaline(spelling??) Which I started taking , but became very drousey all day long, I felt abit like a zombie all day. I have now been taken off these drugs as they did not relieve the pain and put back on codeine phosphate and paracetomel mixed. I have now been referred to have the epidural injections into my lower spine. Are these safe???? do they work????
Please could you let me know
I too suffer have suffered from SPD, since about month 7 during pregnancy. It was self induced as I thought it would be a good idea to run a distance with my bump -.-
But my daughter is 22 months old now. . .and I still live with difficulties. Only minor and rarely painful, I struggle with large flights of stairs. Walking long distances can give me a very 'numb' feeling in my pelvis, and I experience lower backpain (ache) almost constantly. When i swing one leg to far from the other i feel something 'give' -vey diconcerting. Originally I was told that any discomfort would go away by the time my daughter was 6 months old. When I mentioned it to a visiting health worker I was told that SPD "didn't last that long" Now I'm not sure what the next step is. Obviously health proffesionals don't know enough about guiding women with this disorder.
I was advised not to swim the breast stroke too. . .as the pelvic ligerment can't take it. I wonder if there is any equipment at the gym that I should stear clear of?