Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in athletes |
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Authors: | N M Major Clyde A Helms |
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Affiliation: | (1) Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710, USA, US |
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Abstract: | Objective. To demonstrate with radiographic imaging the association between pubic stress injury and sacroiliac abnormalities in athletes.
Design and patients. Eleven athletes (9 men and 2 women), comprising seven male long-distance runners, one male soccer player, one male and two
female basketball players, were imaged with plain films for complaints of pubic symphysis pain, sciatica, groin pain, or a
combination of these complaints. In addition to the plain films, four patients were imaged with CT, two patients had MR imaging,
and a bone scan was performed in three patients. Anteroposterior plain films of the pelvis of 20 patients without back pain
or pubic pain were evaluated for comparison as a control group (ages 18–72 years, average 49 years; 11 women and 9 men). Results. All athletes showed plain film evidence of either sclerosis, erosions or offset at the pubic symphysis. Four had avulsion
of cortical bone at the site of insertion of the gracilis tendon. Four patients demonstrated sacroiliac joint abnormalities
on plain films consisting of sclerosis, erosions and osteophytes, and in one of these athletes, bilateral sacroiliac changes
are present. Two patients with normal sacroiliac joints on plain films had a bone scan showing increased radionuclide uptake
bilaterally at the sacroiliac joints. One patient with both plain film and CT evidence of sacroiliac abnormalities had an
MR examination showing abnormal signal at both sacroiliac joints and at the pubic symphysis. A sacral stress fracture was
found on CT in one patient with complaints of sciatica. In the control group, six patients, all over the age of 55 years,
had mild sclerosis of the symphysis, but no plain film evidence of sacroiliac abnormalities. Conclusion. We have found a group of athletes in whom stress injuries to the pubic symphysis are associated with changes in the sacroiliac
joint as demonstrated by degenerative changes or in the sacrum as manifested as a sacral stress fracture. These findings are
probably due to abnormal stresses across the pelvic ring structure that lead to a second abnormality in the pelvic ring. The
abnormality in the sacrum is not always well seen with conventional imaging. Recognition of the association of stress injury
of the symphysis with back pain is important in that it can help avoid inappropriate studies and diagnostic confusion. |
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Keywords: | Osteitis pubis Sacroiliac osteoarthritis Sacral stress fractures Athletic injuries Stress injuries |
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