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Pubic Symphysitis

This problem is also frequently called osteitis pubis and is a painful overuse injury that affects the pelvis and most commonly occurs during kicking activities. Athletes are at risk, particularly rugby and football players. It affects an area at the front of the pelvis known as the ‘Pubic Symphysis’.

The Pubic Symphysis is a cartilaginous (made from fibrocartilage) joint, that is tightly bound by very strong ligaments. This means that only a very limited amount of movement takes place at this joint.

Pubic-Symphysitis-1

The exact mechanism of the development of symphysitis remains unclear. Several theories have been proposed, including the overuse of the abdominal muscles that attach to the pelvis causing gradual micro trauma to the bone; excessive shearing forces on the Pubic Symphysis caused by powerful kicking or repeated movements; or even instability of the Sacro Iliac joint at the back of the pelvis resulting in abnormalities at the Pubic Symphysis.

The excessive forces overstrain the Pubic Symphysis and cause an inflammatory response. This may involve erosion of the joint margins and is followed by a slow healing process.
Others who tend to have a high risk of developing symphysitis include those with rheumatological diseases and expectant mothers.

Patients tend to present with groin pain that is made worse with activity. It is often tender to palpate the symphysis during examination.

Investigations should include plain xray and this may be combined with MRI scan. It is also important to exclude other causes of groin pain before making the diagnosis.