Re: Osteitis Pubis

[Guest guest]

> Our medical staff are currently conducting a study on OP which should

be

> complete by the end of the year which may shed more light on the

topic, and

> hopefully open up a new angle for treatment and management. I will

alert

> the list when complete.

***

Could you kindly inform me if this research has been published as yet?

Any other research developments regarding osteitis pubis?

Thanks in advance

Carruthers

Wakefield, UK

[Guest guest]

>

> > Our medical staff are currently conducting a study on OP which should

> be

> > complete by the end of the year which may shed more light on the

> topic, and

> > hopefully open up a new angle for treatment and management. I will

> alert

> > the list when complete.

***

I would also be very interested in the research, because two years ago I

was diagnosed with OP and received corticosteroids in my pubic

synthysis for the problem. It seemed to help at first but after three

of them, I gave up on them. A few months later I got a sports hernia

and eventually a stress fracture on my pubic bone. I operated on the

hernia and rested for the fracture and now have 100% recovery, but it

was a tough journey to say the least.

Niklas Arrhenius

Provo, Utah

[Guest guest]

Can you please give us a synopsis of the population you will be studying and

what your work is aimed at more specifically?

One reason I'm asking the question is I see opportunity with regard to females

post childbirth returning to athletics as well as men in a state of pain and

malfunction. Accidental fracture/dislocation vs the intended fracture in

childbirth. I have a client here who still has severe problems 7 years

post-childbirth for example.

Thank you and I will be reading the further thread with interest.

The Phantom

aka Schaefer, CMT, CSCS, competing powerlifter

Denver, Colorado, USA

Re: Osteitis Pubis

>

> > Our medical staff are currently conducting a study on OP which should

> be

> > complete by the end of the year which may shed more light on the

> topic, and

> > hopefully open up a new angle for treatment and management. I will

> alert

> > the list when complete.

<<<I would also be very interested in the research, because two years ago I

was diagnosed with OP and received corticosteroids in my pubic

synthysis for the problem. It seemed to help at first but after three

of them, I gave up on them. A few months later I got a sports hernia

and eventually a stress fracture on my pubic bone. I operated on the

hernia and rested for the fracture and now have 100% recovery, but it

was a tough journey to say the least.>>>

[Guest guest]

>

> Can you please give us a synopsis of the population you will be

studying and what your work is aimed at more specifically?

>

> One reason I'm asking the question is I see opportunity with regard

to females post childbirth returning to athletics as well as men in a

state of pain and malfunction. Accidental fracture/dislocation vs

the intended fracture in childbirth. I have a client here who still

has severe problems 7 years post-childbirth for example.

>

> Thank you and I will be reading the further thread with interest.

***

A few resources below, a number of which have been posted previously:

Osteitis Pubis

Solving a Perplexing Problem

C. Vitanzo, Jr, MD; M. McShane, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 29 - NO.7 - JULY 2001

http://www.physsportsmed.com/issues/2001/07_01/vitanzo.htm

----------------

Osteitis Pubis

Last Updated: September 30, 2005

http://www.emedicine.com/pmr/topic92.htm

-----------------

ATHLETIC MEDICINE

Osteitis Pubis Rehabilitation Protocol

http://home.neb.rr.com/tdufres/pubdoc.html

----------------

Osteitis Pubis

By Frickler

http://www.sportsci.org/encyc/drafts/Osteitis_pubis.doc

==============

Osteitis pubis: a review.

Obstet Gynecol Surv. 1995 Apr;50(4):310-5.

· Lentz SS.

Osteitis pubis is a painful, noninfectious inflammatory condition

that involves the pubic bone, symphysis, and surrounding structures.

Initially associated with urologic procedures, osteitis pubis has

been described as a complication of various obstetrical and

gynecological procedures including vaginal deliveries. An incidence

of approximately 2 to 3 percent has been observed after the Marshall-

Marchetti-Krantz urethropexy. Although the pathogenesis of osteitis

pubis is not clear, periosteal trauma seems to be an important

initiating event. Pain is the primary symptom associated typically

with difficulty in ambulation and the characteristic " waddling gait. "

A low grade fever, elevated sedimentation rate, and mild leukocytosis

may be observed. Radiographic findings which include reactive

sclerosis, rarefaction, and osteolytic changes lag behind the

symptoms by about 4 weeks.

The major differential diagnosis is osteomyelitis; however, the self-

limiting nature and its response to nonantibiotic therapy indicates

that osteitis pubis is a separate clinical entity. Treatment is

directed at the associated inflammation with most minor cases

responding to antiinflammatory agents and bedrest. Other more

recalcitrant cases require more involved therapy including systemic

steroids and rarely surgical resection. The diagnosis of osteitis

pubis should be considered when pelvic pain is present in association

with potential trauma to the symphysis pubis. Also, with more women

participating in sporting activities patients may present to the

physician with osteitis pubis related to athletic injury.

-------------

Groin pain in athletes.

Curr Sports Med Rep. 2006 Dec;5(6):293-9.

· Macintyre J,

· Johson C,

· Schroeder EL.

Groin pain is a common and often frustrating problem in athletes who

engage in sports involving kicking, rapid accelerations and

decelerations, and sudden direction changes. The most common problems

are adductor strain, osteitis pubis, and sports hernia. Other causes

must be considered, including nerve pain, stress fractures, and

intrinsic hip pathology. There is significant overlap and multiple

problems frequently coexist. Accurate diagnosis leads to directed

treatment, with rehabilitation focused on functional closed-chain

strengthening and core stability.

---------------------

Osteitis pubis: an important pain generator in women with lower

pelvic or abdominal pain: a case report and literature review.

Pain Physician. 2005 Jan;8(1):145-7.

· Haider NR,

· Syed RA,

· Dermady D.

BACKGROUND: Osteitis pubis is an aseptic painful inflammatory

condition of the symphysis pubis, surrounding muscles, and tendons.

It was first described in 1924 in patients who had suprapubic

surgery. Inflammation and trauma have been attributed to be causative

factors in previous individual case reports and small case series.

Osteitis pubis is frequently misdiagnosed and is difficult to treat

once it becomes chronic. Results and CONCLUSION: Osteitis pubis is

often a missed entity although pelvic x-ray, scintigraphy, or a

diagnostic/therapeutic steroid and anesthetic injection into the

symphyseal plate can be implemented to diagnose and treat it.

--------------

Osteitis Pubis Syndrome in the Professional Soccer Athlete: A Case

Report

J Athl Train. 2001 Oct–Dec; 36(4): 437–440.

Cristina , * ,* Horacio Lima,* and n

Heinrichs†

http://www.pubmedcentral.nih.gov/articlerender.fcgi?

tool=pubmed & pubmedid=12937486

Objective:

To describe the pathomechanics, diagnostic procedures,

classification, and conservative management of the osteitis pubis

syndrome in the elite soccer athlete.

Background:

Groin injuries can be the most difficult sport injuries to accurately

diagnose and treat. Osteitis pubis is a painful, chronic syndrome

that affects the symphysis pubis, adductor and abdominal muscles, and

surrounding fascia. If misdiagnosed or mismanaged, osteitis pubis can

run a prolonged and disabling course. The abdominal and adductor

muscles have attachments to the symphysis pubis but act

antagonistically to each other, predisposing the symphysis pubis to

mechanical traction microtrauma and resulting in osteitis pubis.

These antagonistic forces are most prevalent in kicking sports, such

as soccer or football.

Description:

We provide a retrospective review of the demographics, diagnostic

criteria and procedures, and conservative management of osteitis

pubis in a professional soccer team. Osteitis pubis represented 3% to

5% of all injuries sustained by our professional soccer team between

1989 and 1997; 71.4% of those presenting with osteitis pubis were

classified as having stage I disease, with a mean recovery time of

26.7 days. Midfielders were most affected by the syndrome (42.8%),

whereas defenders and forwards exhibited equal incidences (25.7%) of

osteitis pubis. Conservative management included nonsteroidal anti-

inflammatory medication, electric stimulation, ultrasound, laser,

cryomassage, and a progressive rehabilitation program.

Clinical Advantages:

Athletes who participated in this conservative management program

appeared to return to full sport participation earlier and with fewer

restrictions than the current literature seems to suggest. A 4-stage

diagnostic criteria system was helpful in determining the course of

treatment.

-------------

Osteitis pubis and assessment of bone marrow edema at the pubic

symphysis with MRI in an elite junior male soccer squad.

Clin J Sport Med. 2006 Mar;16(2):117-22.

· Lovell G,

· Galloway H,

· Hopkins W,

· Harvey A.

OBJECTIVES: To assess bone marrow edema at the pubic symphysis with

magnetic resonance imaging (MRI), and its relation to training and

osteitis pubis in an elite group of junior soccer players. SETTING:

Soccer players on scholarship at the Australian Institute of Sport

(AIS). PATIENTS: Nineteen players from an elite junior men's soccer

squad. INTERVENTION/ASSESSMENT: Serial MRI examinations of the pubic

symphysis over a 4-month training and playing period, training

session questionnaire, and review of clinical diagnosis,

investigations, and records on presentation of athletes with groin

pain at the Department of Sports Medicine.

MAIN OUTCOME MEASURES: Assessment of bone marrow edema (4-point

scale) on MRI scans, review of athlete questionnaires, and review of

clinical records. RESULTS: Initial MRI scans showed moderate to

severe bone marrow edema at the pubic symphysis in 11 of the 18

asymptomatic players. There was a greatly decreased risk of

developing groin pain (osteitis pubis) with more training prior to

entry of the AIS soccer program (odds ratio per 4 sessions of

training, 0.003). The correlation between initial bone marrow edema

grading and pre-AIS training was small. The increase in bone marrow

edema grading from baseline over the scans was 0.5 (90% CL, 0.4).

CONCLUSIONS: Substantial amounts of bone marrow edema at the pubic

symphysis can occur in asymptomatic elite junior soccer players, but

it is only weakly related to the development of osteitis pubis.

Progressing training loads more slowly in athletes presenting with

low current training loads may be a useful strategy for the

prevention of osteitis pubis in junior soccer players.

-----------------

Successful treatment of osteitis pubis by using totally

extraperitoneal endoscopic technique.

Int J Sports Med. 2005 May;26(4):303-6.

· Paajanen H,

· Heikkinen J,

· Hermunen H,

· Airo I.

Osteitis pubis is characterized by pain, inflammation, and sclerosis

in the pubic symphysis. It is often a self-limiting disease in

athletes, but persistent pain may occasionally need surgery. Video-

assisted placement of extraperitoneal retropubic synthetic mesh to

support the damaged area may hasten the healing of this injury.

During 1997 - 2002 five elite level male athletes with chronic groin

pain associated with osteitis pubis were operated. The diagnosis was

based on clinical findings, x-ray, magnetic resonance imaging (MRI),

and isotope bone scanning. A 10 x 15 cm polypropylene mesh was placed

into preperitoneal retropubic space using video-assisted technique.

The pain and return to sport were asked at 1, 6, and 12 months after

surgery. Preoperative technetium bone scan revealed an enhanced

isotope uptake of pubic bone in each patient. T2-weighted MRI (n = 3)

indicated bone marrow edema, which was decreased postoperatively on

repeated MRI scans. Periosteal edema and irritation were also seen at

operation. No complications were associated with the insertion of

mesh. All 5 athletes returned to their sport activities between one

to two months after surgery. After one year, no tenderness or pain

was observed in the pubic bone. When conservative treatment fails,

the placement of retropubic mesh is safe and a mini-invasive method

to hasten the rehabilitation of osteitis pubis in selected cases. The

postoperative recovery was uneventful, and the patients returned

rapidly to their sporting activities.

=============

Any others?

Carruthers

Wakefield, UK