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Saad A, Iyengar KP, Kurisunkal V, Morris G, Davies AM, Botchu R. Isolated lesions of the pubis. Clin Radiol 2023; 78:724-729. [PMID: 37453806 DOI: 10.1016/j.crad.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 07/18/2023]
Abstract
The osseous pelvis is a well-known area of various primary and secondary bone tumours, tumour mimics, and infections. Isolated lesions of the pubis (ILP) are rare, with few case reports in the literature. Given their sparsity, such lesions may pose a great diagnostic challenge due to varied clinical presentations and imaging features. In this study, we report the largest case series of ILP. We discuss the patient demographics, differentials, surgical approaches, and management.
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Affiliation(s)
- A Saad
- Departments of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - K P Iyengar
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - V Kurisunkal
- Departments of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - G Morris
- Departments of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
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Yanagita Y, Shimada R, Noda K, Ikusaka M. Pubic Osteomyelitis in a Young Athlete. Cureus 2023; 15:e35329. [PMID: 36968939 PMCID: PMC10038743 DOI: 10.7759/cureus.35329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
We describe a case of pubic osteomyelitis in a 17-year-old Japanese male. The patient presented with acute left groin pain and left lower quadrant pain. He was evaluated at another hospital where pelvic X-ray/computed tomography was normal, and laboratory testing revealed only high C-reactive protein. Pelvic magnetic resonance imaging (MRI) on day three showed inflammation of the pubic attachment of the rectus abdominis muscle. Furthermore, a pelvic MRI performed 10 days after onset revealed a high signal on T2 short-TI inversion recovery in the left pubic bone, which was not found in the previous MRI, leading to a diagnosis of left pubic osteomyelitis. Symptoms improved rapidly after antibiotic therapy, and treatment was completed after six weeks. When a young athlete presents with fever and acute inguinal pain, osteomyelitis of the pubic bone should be considered as a differential diagnosis. This case report emphasizes the importance of taking a sports history during the interview and performing a repeat MRI for the early diagnosis of osteomyelitis of the pubic bone.
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Mohammad WS, Elsais WM. Comparison of hip abductor and adductor muscle performance between healthy and osteitis pubis professional footballers. Ir J Med Sci 2022; 192:685-691. [PMID: 35426013 DOI: 10.1007/s11845-022-03010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aimed to compare the concentric and eccentric muscle performance of the hip abductor and adductor muscles at a high angular velocity in football players with osteitis pubis and healthy players. METHODS A total number of 32 male football players with osteitis pubis and 20 healthy footballers were tested using an isokinetic dynamometer at a speed of 180°/s. Hip abductor and adductor peak torque/body weight, time to peak torque, acceleration, and deceleration times produced during concentric and eccentric muscle contraction modes were measured using a Biodex dynamometer. RESULTS Football players with osteitis pubis demonstrated a significantly higher time to peak torque, acceleration, and deceleration times (p < 0.05); however, when compared to healthy athletes, there was no significant change in muscle strength. CONCLUSION The present study showed that football players with osteitis pubis had a reduction in neuromuscular reaction. Therefore, the reaction time of these muscles is critical, and the reduction could result in magnified stresses and/or poorly distributed loads across the musculotendinous structure of the anterior pelvis, which presumably could lead to the development of osteitis pubis. Incorporate findings of the current study in clinical practice could afford critical information when evaluating the hip muscles in football players with osteitis pubis, for pre-screening, enhancing the rehabilitation programs, and guiding the decision of returning to sports after injury.
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Affiliation(s)
- Walaa S Mohammad
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, 11952, Saudi Arabia.
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
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Wechsler B, Devries J, Yim D. Pubic symphysis osteomyelitis with associated vesico-symphyseal fistula: a difficult diagnosis. BMJ Case Rep 2021; 14:e244336. [PMID: 34544709 PMCID: PMC8454438 DOI: 10.1136/bcr-2021-244336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
Pubic symphysis osteomyelitis is an infectious complication that rarely arises in men who have undergone treatment for prostate cancer. This process may more rarely arise from a fistulous tract between the pubic symphysis and the urinary tract. In this case report, we discuss the most common clinical presentations and laboratory findings that lead to the diagnosis of this disease process, as well as the role of MRI and other imaging modalities in confirmation of the diagnosis. This case serves as a reminder to clinicians to have earlier consideration of pubic symphysis osteomyelitis in their differential diagnosis to reduce the risk of long-term complications associated with undertreatment.
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Affiliation(s)
- Brendan Wechsler
- Medical Student Affairs, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Jonah Devries
- Medical Student Affairs, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Douglas Yim
- Interventional Radiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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Esser S, Rosario-Concepción RA, Sherman C. My Groin Is About to Explode: Pain in an Ultrarunner. Curr Sports Med Rep 2020; 19:104-106. [PMID: 32141903 DOI: 10.1249/jsr.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glasser JG. Case report: Osteitis/osteomyelitis pubis simulating acute appendicitis. Int J Surg Case Rep 2018; 53:269-272. [PMID: 30447548 PMCID: PMC6240723 DOI: 10.1016/j.ijscr.2018.10.077] [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] [Received: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022] Open
Abstract
There is a continuum between Athletic (Sports) Hernia, Osteitis Pubis, and Osteomyelitis Pubis. The pubis is the site of attachment of many “core” muscles. A lay term used to describe a hernia is “rupture”. Athletic hernia denotes a tear. Chronic musculotendinous strain may cause inflammation (osteitis pubis). An inflammatory focus may become a nidus for infection (osteomyelitis pubis). The symptoms caused by these three entities blur one with the other and with those characterizing acute appendicitis. This is an important association for clinicians to know.
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Affiliation(s)
- James G Glasser
- Janet Weis Children's Hospital, Geisinger Medical Center, 100N. Academy Ave., Danville, PA 17822, United States.
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Spontaneous Septic Arthritis of Pubic Symphysis in an Elite Athlete. Case Rep Surg 2016; 2016:6384707. [PMID: 27703831 PMCID: PMC5039270 DOI: 10.1155/2016/6384707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/28/2016] [Indexed: 12/02/2022] Open
Abstract
Septic arthritis of the pubic symphysis is a potentially severe disease. Athletes are at risk of this form of spontaneous arthritis, as inflammation of the pubic bone due to muscular stress is relatively common. Oedema due to inflammation might predispose to infection through bacteraemia or local bacterial translocation. Suspicion should be raised when an athlete complains of groin pain and has signs of infection (i.e., fever, elevated white blood cell count, and elevated C-reactive protein). Diagnosis is made by imaging showing signs of inflammation combined with positive (blood) cultures. Broad spectrum antibiotics should be started upon suspicion and adjusted according to cultures. An abscess causing clinical deterioration under antibiotic treatment is an indication for invasive intervention (i.e., surgical or image-guided drainage). This is the first case of spontaneous septic arthritis of the pubic symphysis in an athlete requiring surgical and additional image-guided drainage.
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Mohammad WS, Abdelraouf OR, Elhafez SM, Abdel-Aziem AA, Nassif NS. Isokinetic imbalance of hip muscles in soccer players with osteitis pubis. J Sports Sci 2014; 32:934-9. [PMID: 24499182 DOI: 10.1080/02640414.2013.868918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this study, we compared the isokinetic torques of hip flexors/extensors and abductors/adductors in soccer players suffering from osteitis pubis (OP), with normal soccer players. Twenty soccer male athletes with OP and 20 normal soccer athletes were included in this study. Peak torque/body weight (PT/BW) was recorded from hip flexor/extensor and abductor/adductor muscles during isokinetic concentric contraction modes at angular velocity of 2.1 rad · s(-1), for both groups. The results showed a significant difference between the normal and OP groups for hip flexors (P < 0.05). The normal group had significant, lower PT/BW value than the OP group for their hip flexors (P < 0.05). The hip flexor/extensor PT ratio of OP affected and non-affected limbs was significantly different from that of normal dominant and non-dominant limbs. There were no significant differences between the normal and OP groups for hip extensor, adductor and abductor muscles (P > 0.05). Regarding the hip adductor/abductor PT ratio, there was no significant difference between the normal and OP groups of athletes (P > 0.05). The OP group displayed increase in hip flexor strength that disturbed the hip flexor/extensor torque ratio of OP. Therefore, increasing the hip extensor strength should be part of rehabilitation programmes of patients with OP.
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Affiliation(s)
- Walaa Sayed Mohammad
- a Department of Biomechanics, Faculty of Physical Therapy , Cairo University , Giza , Egypt
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There's a hole in my symphysis -- a review of disorders causing widening, erosion, and destruction of the symphysis pubis. Clin Radiol 2012; 68:173-80. [PMID: 22748520 DOI: 10.1016/j.crad.2012.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 02/26/2012] [Accepted: 03/06/2012] [Indexed: 11/20/2022]
Abstract
The symphysis pubis is demonstrated on many conventional radiographic and cross-sectional examinations and abnormality of the symphysis pubis is a common imaging finding with numerous possible causes. Many significant disorders that affect the symphysis pubis cause it to appear widened, eroded, or destroyed on imaging studies. It is useful for radiologists to have a working differential diagnosis for these appearances, to use when reporting such studies. This review briefly describes the anatomy of the symphysis pubis and presents examples of the various developmental, inflammatory, infectious, neoplastic, traumatic, and metabolic disorders that may cause it to become widened, eroded, or destroyed. Some disorders have pathognomonic imaging features. Others give rise to similar findings that depend more on overall disease activity, rather than the specific diagnosis itself. In such cases, correlation with clinical and laboratory findings will help narrow the differential diagnosis.
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LAWFORD AM, SCOTT K, LUST K. A case of massive vulvar oedema due to septic pubic symphysitis complicating pregnancy. Aust N Z J Obstet Gynaecol 2010; 50:576-7. [DOI: 10.1111/j.1479-828x.2010.01227.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med 2008; 45:57-64. [PMID: 18812419 DOI: 10.1136/bjsm.2008.050989] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence. METHODS Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL-were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review. RESULTS There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis. CONCLUSIONS The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.
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Affiliation(s)
- Haemi Choi
- The Ohio State University Sports Medicine Center, Columbus, 43221, USA.
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Naqvi N, Naqvi R, Wong C, Pearce S. A novel observation of pubic osteomyelitis due to Streptococcus viridans after dental extraction: a case report. J Med Case Rep 2008; 2:255. [PMID: 18671843 PMCID: PMC2517070 DOI: 10.1186/1752-1947-2-255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 07/31/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Pubic osteomyelitis should be suspected in athletic individuals with sudden groin pain, painful restriction of hip movements and fever. It is an infrequent and confusing disorder, which is often heralded by atypical gait disturbance and diffuse pain in the pelvic girdle. The most common pathogen is Staphylococcus aureus but, on occasions, efforts to identify infectious agents sometimes prove negative. Pubic osteomyelitis due to Streptococcus viridans has not been reported previously in the literature. Case presentation We describe the case of a fit 24-year-old athlete, who had a wisdom tooth extracted 2 weeks prior to the presentation, which could have served as a port of entry and predisposed the patient to transient bacteraemia. Conclusion S. viridans is well known for causing infective endocarditis of native damaged heart valves, but to the best of the authors' knowledge it has not been reported previously as a cause of pubic osteomyelitis. We believe that this case should alert physicians to the association between dental procedures and osteomyelitis of the pubis secondary to S. viridans.
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Affiliation(s)
- Naseem Naqvi
- Department of Acute Medicine, Dumfries & Galloway Royal Infirmary, UK.
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