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Randy Dixon -> Re: Early Capsular Pattern of the Hip (August 27, 2005 4:29:00 AM)
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Also have you considered musculoskeletal myth #7.
Osteitis Pubis:
Presenting complaints include the insidious development of progressively worsening pain--unilateral or bilateral groin (inguinal), medial thigh, testicular, scrotal, perineal, suprapubic, anterior pubic area, and/or hip--along with restricted motion. Pain is often described as sharp, stabbing, or even burning and is exacerbated by running, pivoting (especially one-legged), twisting, climbing stairs, kicking, sit-ups, leg raises, or Valsalva maneuvers (2-19). Patients may have difficulty lying in bed at night (5,14). If instability is present, patients may describe an audible or palpable clicking sensation at the symphysis pubis with certain activities (eg, arising from a seated position, turning in bed, or walking on uneven surfaces) (6,9,10,13,14,19). Rest usually relieves the symptoms, but not entirely.
Physical exam. Usually, tenderness is present on palpation of the area over the pubic symphysis (4-18), and there may be either unilateral or bilateral discomfort with palpation over the superior (rectus abdominus) and/or inferior (adductors) pubic rami (2,4-6,11-15). Hip motion can be restricted because of surrounding muscle spasm, especially of the adductors (2,5,6,10,12,14,15). Passive hip abduction or resisted hip adduction and flexion may elicit pain (2,5,6,8-16,18,19). Specific tests, such as the lateral pelvic compression or cross-leg tests, are often positive (6,9,10,12,14). Trendelenburg's test, if positive, indicates weak hip abductors (12). In severe cases, patients may demonstrate a wide-based (antalgic) gait disturbance, with the hips and knees partially flexed (6,9,10,14,17).
Imaging. Plain radiographs (AP and lateral) of the pelvis are an integral component in the diagnostic workup. However, it is important to realize that most abnormalities are not specific for osteitis pubis, and radiographs can lag behind clinical symptoms by as much as 4 weeks (9,11-13,16,17).
Early in the course, it is not uncommon for radiographs to be normal (2,6,7,9-11,17). After about 4 weeks, findings such as unilateral or bilateral fraying or roughening of the marginal periosteum and widening of the symphysis joint space may be seen (2-19). As the disease progresses over several months, radiographic changes include reactive sclerosis of adjacent pubic bones, erosion and resorption of the symphysis margins, and widening of the joint space (2-10,12-19). Bilateral, symmetric rarefaction and cortical bone destruction are common findings (7-9,14,16,17). Gradual reossification with complete restoration of the joint is associated with healing and can take several months. Residual sclerosis, osteophytes, and cysts may occur (3-8,14). Additional one-legged, standing flamingo views are beneficial if instability is suspected (3-5,8,12,13,19). Instability is defined as greater than 2 mm of height difference between the superior rami of the symphysis (4,13,19). Many experts also recommend sacroiliac joint films since they are frequently involved in the process (3,5,8,12-14).
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