Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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N.A. Al-Enazi and B.P. Jacob
Fig. 41.2. Right inguinal hernia on MRI.
Physical findings for osteitis pubis can vary. It is important always to
consider any sport involved, as well as the chronicity of the conditions
[ 3 ]. Gradual onset of pelvic pain, with pubic symphysis tenderness, is
one of the features of osteitis pubis [ 4 ]. One great modality for the diagnostic
investigation in detecting the osteitis pubalgia is MRI. The differential
diagnoses of chronic groin pain that can present similarly to
osteitis pubis include musculotendinous strain, osteomyelitis, inguinal
hernia, referred low back pain, intra-articular hip disease and genitourinary
disease, and adductor tendinopathy. Osteomyelitis of the pubic
symphysis is one of the diseases most commonly confused with osteitis
pubis [ 5 ], so clinical evaluation requires a careful synthesis of history
taking, physical examination, and appropriately directed investigation.
Discussion
Osteitis pubis, a rare condition, is characterized by pelvic pain localized
over the symphysis pubis, in the lower abdominal muscles or in the
perineum. The pain may radiate to the adductor region of the thigh, and
patients may describe painful adductor muscle spasms. Aggravating factors
are walking and standing from a seated position.
Osteitis pubis, also known as pubalgia or sometimes mislabeled as
just athletic pubalgia, is one of the most chronic and debilitating syndromes
affecting athletes [ 6 ]. It is described as the pubic bone stress