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Adegboyega MT, Jhanjar S, Grote MN, Weaver TD. Predicting the shape, size, and placement of adult human pubic symphyses. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 181:182-194. [PMID: 36939148 DOI: 10.1002/ajpa.24725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES When reconstructing fossil pelves, the articulation of the pelvic bones largely relies on subjective decisions by researchers. Different positionings at the pubic symphysis can affect the overall morphology of the pelvis and the subsequent biological interpretation associated with that individual or species. This study aims to reduce this subjectivity using quantitative models to predict pubic symphysis morphology. METHODS We collected 3D landmarks and semilandmarks on the pubic symphysis and adjacent aspects on the CT scans of 103 adults. Using geometric morphometrics we, (1) quantified pubic symphysis morphology, (2) trained simple and two-stage least-squares linear regression models to predict pubic symphysis shape, and (3) assessed the shape variation in the sample. The model with the lowest prediction error was identified as the best model. Principal components analysis was used to explore the effects of each variable on shape and hypothetical shapes were generated from the model to illustrate these effects. RESULTS The best model is a two-stage least-squares model that predicts pubic symphysis size at the first stage using additive effects of sex and age, then subsequently interacts pubic symphysis size with sex and age at the second stage to predict pubic symphysis shape. Other models with low prediction errors included variables reflecting pelvic size and breadth. CONCLUSION Linear regression modeling can be used to systematically predict pubic symphysis morphology. This method can be used in addition to other techniques to improve fossil reconstructions by more accurately estimating the morphology of this region of the pelvis.
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Affiliation(s)
- Mayowa T Adegboyega
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, USA
- Department of Anthropology, University of California, Davis, California, USA
| | - Sara Jhanjar
- Department of Anthropology, University of California, Davis, California, USA
- College of Osteopathic Medicine, California Health Sciences University, Clovis, California, USA
| | - Mark N Grote
- Department of Anthropology, University of California, Davis, California, USA
| | - Timothy D Weaver
- Department of Anthropology, University of California, Davis, California, USA
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Starzec-Proserpio M, Lipa D, Szymański J, Szymańska A, Kajdy A, Baranowska B. Association Among Pelvic Girdle Pain, Diastasis Recti Abdominis, Pubic Symphysis Width, and Pain Catastrophizing: A Matched Case-Control Study. Phys Ther 2022; 102:6497843. [PMID: 35079827 PMCID: PMC9046967 DOI: 10.1093/ptj/pzab311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Pregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women's lives. There is uncertainty regarding the association between the structures of the bony pelvis, diastasis recti abdominis (DRA), pain processing, and PGP and to what extent these factors should be considered during physical therapy. This study aimed to evaluate the differences between women with and without PGP shortly after delivery regarding the separation of a pubic symphysis, DRA, and pain catastrophizing. METHODS Women diagnosed with PGP 24 to 72 hours after vaginal delivery were matched to pain-free controls according to age and parity. Ultrasound evaluations of diastasis recti (interrecti distance [IRD]) during rest and curl-up task and pubic symphysis (interpubic width) were performed. The Pain Catastrophizing Scale was used to assess the level of catastrophizing. A special Cox regression model was used to fit a conditional logistic regression for a 1:2 matched case-control study. RESULTS Thirty-five women with clinically diagnosed PGP and 70 matched controls were included in the study. The PGP group had a significantly higher pre-pregnancy body mass index than the control group. After adjusting for body mass index in multiple conditional logistic regression, the interpubic distance (odds ratio = 1.64; 95% CI = 1.22 to 2.20) and IRD during curl-up (odds ratio = 2.01; 95% CI = 1.08 to 3.74) were significantly associated with PGP. Pain catastrophizing and IRD at rest were not associated with PGP in univariable or multivariable analysis. CONCLUSIONS Pain catastrophizing is similar for women with and without PGP early postpartum. However, the degree of the pubic symphysis and rectus abdominis separation during the curl-up task are positively associated with PGP shortly after delivery. IMPACT This study indicates that a reconsideration of the way we look at DRA is warranted. The development of a more comprehensive assessment including objective measurements and a biopsychosocial understanding is needed to inform directions for further postpartum physical therapy.
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Affiliation(s)
| | - Daria Lipa
- St. Sophia Specialist Hospital, Warsaw, Poland
| | - Jacek Szymański
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Agata Szymańska
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Müller M, Greve F, Zyskowski M, Wurm M, Biberthaler P, Kirchhoff C. [External fixation for treatment of peripartum pubic symphysis separation : Clinical case and discussion]. Unfallchirurg 2020; 124:673-677. [PMID: 33336261 PMCID: PMC8370944 DOI: 10.1007/s00113-020-00936-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
A complete peripartum pubic symphysis separation is a rare but severe complication of natural birth. Its incidence is estimated to be 0.03-3 ‰. Minor partial separations with a small width can be treated with a pelvic binder. Separations with major dehiscence should be treated by surgical reduction and fixation. This article presents the case of a 30-year-old woman who suffered a complete rupture of the pubic symphysis during the birth of her second child. Radiographic dehiscence was 39 mm. The operative treatment was carried out using a supra-acetabular external fixator for 12 weeks with a good result.
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Affiliation(s)
- M Müller
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - F Greve
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - M Zyskowski
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - M Wurm
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - C Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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Choo HJ, Hwang SK, Hynes CK. Musculoskeletal Issues and Care for Pregnant and Postpartum Women. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Aydın S, Bakar RZ, Aydın ÇA, Özcan P. Assessment of postpartum symphysis pubis distention with 3D ultrasonography: a novel method. Clin Imaging 2016; 40:185-90. [PMID: 26995568 DOI: 10.1016/j.clinimag.2015.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/17/2015] [Accepted: 10/30/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Determining the accuracy of three-dimensional (3D) sonographic measurement of symphysis pubis (SP) distension in comparison to plain X-ray pelvic radiographs and assessing the interperformer reliability of this method. METHODS Pelvic X-ray was performed on 86 women who delivered singleton babies within 36 h of delivery then each woman was examined by 3D transperineal ultrasound imaging by two sonogrographers. RESULTS Measurements of SP with 3D transperineal ultrasonography in comparison to pelvic X-ray showed 95% limits of agreement. Interperformer reproducibility was substantial (interclass correlation coefficient 0.66-0.70) for measures of SP. CONCLUSIONS Pubic symphysis width, superior pubic ligament length, and SP height can be reliably measured with 3D ultrasonography.
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Affiliation(s)
- Serdar Aydın
- Bezmialem University Obstetric and Gynecology Department, İstanbul, Turkey.
| | - Rabia Zehra Bakar
- Bezmialem University Obstetric and Gynecology Department, İstanbul, Turkey
| | | | - Pınar Özcan
- Bezmialem University Obstetric and Gynecology Department, İstanbul, Turkey
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Herren C, Sobottke R, Dadgar A, Ringe MJ, Graf M, Keller K, Eysel P, Mallmann P, Siewe J. Peripartum pubic symphysis separation--Current strategies in diagnosis and therapy and presentation of two cases. Injury 2015; 46:1074-80. [PMID: 25816704 DOI: 10.1016/j.injury.2015.02.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/26/2015] [Accepted: 02/28/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation. METHODS This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered. RESULTS Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48 h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions. SUMMARY Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.
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Affiliation(s)
- C Herren
- University Clinic RWTH Aachen, Department of Trauma and Reconstructive Surgery, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - R Sobottke
- Medical Center of the City/Region Aachen GmbH, Center for Orthopedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany
| | - A Dadgar
- University of Oklahoma-Tulsa, Department of Orthopedics, 2424 E 21st Street Suite 320, Tulsa, 74113 OK, United States
| | - M J Ringe
- Medical Center of the City/Region Aachen GmbH, Center for Orthopedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany
| | - M Graf
- Medical Center of the City/Region Aachen GmbH, Center for Orthopedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany
| | - K Keller
- University Hospital Cologne, Clinic and Polyclinic for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Köln, Germany
| | - P Eysel
- University Hospital Cologne, Clinic and Polyclinic for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Köln, Germany
| | - P Mallmann
- University Hospital Cologne, Clinic and Polyclinic for Obstetrics and Gynecology, Kerpener Str. 62, 50937 Köln, Germany
| | - J Siewe
- University Hospital Cologne, Clinic and Polyclinic for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Köln, Germany
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Becker I, Stringer MD, Jeffery R, Woodley SJ. Sonographic anatomy of the pubic symphysis in healthy nulliparous women. Clin Anat 2014; 27:1058-67. [PMID: 24904004 DOI: 10.1002/ca.22423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 11/06/2022]
Abstract
Pregnancy-related symphyseal pain is a condition commonly encountered by clinicians but its pathogenesis is poorly understood. The pubic symphysis is readily visualized with ultrasound, yet the normal sonographic anatomy of the joint has not been accurately documented. This study aimed to describe the anatomy of the pubic symphysis in healthy, nulliparous women using ultrasound. An experienced and inexperienced sonographer scanned the joint in 30 female volunteers (mean age 26 years). Interobserver and intraobserver reliability of ultrasound measurements were examined and the accuracy of these measurements was validated by ultrasound and dissection of six female cadaver pelves (mean age 75 years). In healthy young women, pubic symphysis morphology varied, and six categories of anterosuperior joint shape were defined. Mean values of several anatomic parameters were obtained in supine and standing positions: joint width (widest 10.1 mm, narrowest 2.6 mm); superior pubic ligament (SPL) length and depth (41.4 and 3.4 mm, respectively); and pubic crest length (left 24.4 mm, right 24.4 mm). Statistically significant relationships between SPL width and depth and anthropometric variables (body mass index, pelvic width, and body fat percentage) were established. Larger ultrasonographic measurements, such as wide joint width and SPL length, could be measured more reliably than smaller measurements, such as narrow joint width and SPL depth, in both healthy volunteers and cadavers. Findings from this study provide normative reference data for examination of the pubic symphysis in pregnant women and may therefore be relevant to understand pregnancy-related symphyseal pain.
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Affiliation(s)
- Ines Becker
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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Irwin RW, Watson T, Minick RP, Ambrosius WT. Age, body mass index, and gender differences in sacroiliac joint pathology. Am J Phys Med Rehabil 2007; 86:37-44. [PMID: 17304687 DOI: 10.1097/phm.0b013e31802b8554] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the correlation between age, gender, and body mass index as they relate to sacroiliac joint pathology diagnosed by dual comparative local anesthetic blocks. DESIGN This was a retrospective review of patients at a university spine center from August 2001 until August 2004. RESULTS One hundred fifty-eight patients underwent sacroiliac joint (SIJ) injections with average symptom duration of 34.0 mos. Of those patients, 26.6% were found to have SIJ pain by dual injections. The average age of this group was 53.3 yrs old; for those who had negative injections, it was 46.8 yrs old (P = 0.0025). The body mass indexes for the positive and negative SIJ pain groups were 30.2 and 29.3 kg/m2 (P = 0.40), respectively. The gender makeup of the positive and negative groups showed 64.3% female and 62.1% female (P = 0.85), respectively. Smoking tobacco status was not statistically significant between the two groups, with 29.6% of smokers having a positive block and 26.1% having a negative block (P = 0.35). CONCLUSIONS Our results suggest an age difference for those patients who have SIJ pain. These patients tend to be older than those without. Gender, age, and smoking status were not found to correlate with SIJ pathology.
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Affiliation(s)
- Robert W Irwin
- Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL 33101, USA
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Röst CCM, Jacqueline J, Kaiser A, Verhagen AP, Koes BW. Pelvic pain during pregnancy: a descriptive study of signs and symptoms of 870 patients in primary care. Spine (Phila Pa 1976) 2004; 29:2567-72. [PMID: 15543075 DOI: 10.1097/01.brs.0000145416.22782.9f] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The authors conducted a cross-sectional analysis. OBJECTIVE The objective of this study was to describe the signs and symptoms of pregnant women with pain and dysfunction in the pelvic area. SUMMARY OF BACKGROUND DATA Pelvic pain during pregnancy is common with incidence rates of 48% to 56%. The exact cause of pelvic pain during pregnancy is still unclear. Also unclear is the association between physical examination and the occurrence of pelvic pain during pregnancy. METHODS Pregnant women with pelvic pain were sent for treatment to 2 physical therapy practices between January 1997 and January 2002. A standardized clinical examination protocol and an extensive questionnaire were used to obtain relevant clinical and demographic characteristics. RESULTS In total, 870 women were included. The average score of the overall severity of the complaints was 7.8 (scale 0-15). Main complaints were located around the sacroiliac joints (76.6%) and the pubic symphysis (57.2%). The area of pain was not related to positive signs in passive hip movements and sacroiliac tests. The highest positive test results were found for Patrick sign (71.7%), active straight leg raise (ASLR) test (66.4%), resisted adduction (54.4%), and passive hip abduction (36.9%). Overall severity of complaints was related to age, number of weeks pregnant, passive hip flexion and internal rotation, and swimming. The total explained variance of these factors was 15.9%. No relationship was found between overall complaints and sacroiliac tests, pelvic pain during a previous pregnancy, extremely painful or type of previous deliveries. CONCLUSIONS Pregnant patients with pelvic pain show a considerable level of complaints. The overall severity of complaints is not related to previous peripartum pelvic pain or type of deliveries or to commonly used tests. Further study on the role of clinical examination, including passive flexion and internal rotation of the hip joints, is recommended.
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