Osteitis pubis (OP) is characterised 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 aetiology is sometimes unknown, the most common causes are:
- pregnancy/childbirth 2
- high-level of athletic activity: see athletic pubalgia
- urological or gynaecological 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 oedema although this finding may also be seen in asymptomatic individuals. Symphyseal fluid and peripubic soft-tissue oedema 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.
- 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