Osteitis pubis

Last revised by Dr Calum Worsley on 16 Dec 2021

Osteitis pubis 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:

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 is symptomatic and mainly relies upon rest. Symphyseal cleft injections can be performed for diagnostic and therapeutic measures, demonstrating short-term symptom relief in a 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.

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Cases and figures

  • Case 1
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  • Case 2
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  •  Case 3: MRI
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  • Case 4: CT
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  • Case 5: in ankylosing spondylitis
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  • Case 6
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  • Case 7
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  • Case 8
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  • Case 9
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  • Case 10
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