Osteitis Pubis

THE CLINICAL SYNDROME

Osteitis pubis a constellation of symptoms consisting of a localized tenderness over the symphysis pubis, pain radiating into the inner thigh, and waddling gait. Characteristic radiographic changes consisting of erosion, sclerosis, and widening of the symphysis pubis are pathognomonic for osteitis pubis decade, osteitis pubis affects females more frequently than males. Osteitis pubis occurs most commonly after bladder, inguinal, or prostate surgery and is thought to be due to hematogenous spread of infection to the relatively avascular symphysis pubis. Osteitis pubis can appear without an obvious inciting factor or infection.

SIGNS AND SYMPTOMS

On physical examination, the patient will exhibit point tenderness over the symphysis pubis. The patient may be tender over the anterior pelvis and may note that the pain radiates into the inner thigh with palpation of the symphysis pubis. Patients may adopt a waddling gait in order to avoid movement of the symphysis pubis. This dysfunctional gait may result in lower extremity bursitis and tendonitis, which may confuse the clinical picture and further increase the patient’s pain and disability.

Patients with osteitus pubis will often develop a waddling galt.

TREATMENT

Initial treatment of the pain and functional disability associated with osteitis pubis should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. For patients who do not respond to these treatment modalities, the following injection technique with local anesthetic and steroid may be a reasonable next step. Injection for osteitis pubis is carried out by placing the patient in the supine position.

Osteitis pubis should be suspected in patients presenting with pain over the pubic symphysis in the absence of trauma. The above injection technique is extremely effective in the treatment of osteitis pubis. The use of physical modalities, including local heat, as well as gentle stretching exercises, should be introduced several days after the patient undergoes this injection technique. Vigorous exercises should be avoided as they will exacerbate the patient’s symptomatology. Simple analgesics, nonsteroidal anti-inflammatory drugs, and antimyotonic agents such as tizanidine may be used concurrently with this injection technique.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue. Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.