Osteitis Pubis and Instability of the Pubic Symphysis

2000 ◽  
Vol 28 (3) ◽  
pp. 350-355 ◽  
Author(s):  
Paul R. Williams ◽  
Daniel P. Thomas ◽  
Edward M. Downes
Keyword(s):  
Pubic Symphysis ◽  
Vertical Displacement ◽  
Nonoperative Treatment ◽  
Osteitis Pubis ◽  
Nonoperative Therapy ◽  
Vertical Instability ◽  
Compression Plate ◽  
Cause Of Failure ◽  
Rugby Players

Seven rugby players with osteitis pubis and vertical instability at the pubic symphysis were treated operatively after nonoperative treatment had failed to improve their symptoms. The vertical instability was diagnosed based on flamingo view radiographs showing greater than 2 mm of vertical displacement. The players had undergone at least 13 months of nonoperative therapy before surgery was considered. Operative treatment consisted of arthrodesis of the pubic symphysis by bone grafting supplemented by a compression plate. At a mean follow-up of 52.4 months, all patients were free of symptoms and flamingo views confirmed successful arthrodesis with no residual instability of the pubic symphysis. Based on our results with this procedure, we believe that arthrodesis of the pubic symphysis has a role in the treatment of osteitis pubis that is recalcitrant to nonoperative treatment. The combination of osteitis pubis and vertical pubis symphyseal instability may be the cause of failure of nonoperative treatment.

scholarly journals Joint Space Injection for Osteitis Pubis in an Airborne Jump Injury: A Case Report

2019 ◽  
Vol 185 (7-8) ◽  
pp. e1298-e1299
Author(s):  
Jackson P Beall ◽  
Joshua J Oliver ◽  
Rachel E Bridwell ◽  
Scott E Young
Keyword(s):  
Sports Medicine ◽  
Groin Pain ◽  
Pubic Symphysis ◽  
Joint Space ◽  
Treatment Modalities ◽  
Osteitis Pubis ◽  
Jump Exercise ◽  
Repetitive Stress ◽  
First Time

Abstract Osteitis Pubis (OP) is groin pain caused by overloading stresses on the pubic symphysis. This is often caused by the repetitive stress seen in competitive sports, but can also be caused by rapid acceleration or deceleration. It is a diagnosis of exclusion made after other entities such as fracture or infection are ruled out. It is often treated conservatively with rest, Non-Steroidal Anti-inflammatories (NSAIDS), and Physical Therapy (PT). After these treatment modalities have failed, intra-articular injection with local anesthetics and steroids can be considered. We report a case of a 22-year-old Male Active Duty Army Soldier who presented with OP immediately after landing during a routine Airborne Jump exercise. The Soldier reported landing in such a way that his feet did not impact the ground at the same time, creating a sheering force on his pelvis. Following two months of failed treatment involving NSAIDS and PT, the patient was referred to Sports Medicine where he received an injection of 1 mL of 1% lidocaine and 40 mg of triamcinolone into the pubic symphysis joint space. Shortly afterward the patient endorses complete resolution of his symptoms without return of symptoms at 1-month follow-up. Although injection of the pubic symphysis with local anesthetic and steroids has been previously described, this is the first time it has been described in a jump injury.

scholarly journals Osteochondroma of the pubic symphysis causing hematuria: a case report and literature review

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Li-cheng Song ◽  
Qian Xu ◽  
Hui Li ◽  
Zhi-jun Li ◽  
Ya Li ◽  
...  
Keyword(s):  
Bladder Tumor ◽  
Multidisciplinary Approach ◽  
Bladder Tumour ◽  
Surgical Excision ◽  
Pubic Symphysis ◽  
Careful Analysis ◽  
Bone Neoplasm ◽  
Imaging Data ◽  
Case Presentation

Abstract Background Osteochondroma is the most common benign bone neoplasm and is sometimes referred to as osteocartilaginous exostosis. The symptoms caused by osteochondroma are rare, especially the urogenital complications. Therefore, this tumour is sometimes misdiagnosed. Case presentation This report described a 70-year-old woman with hematuria who was initially misdiagnosed with a bladder tumour in the outpatient department by a urologist. However, during cystoscopy, we found that the mass did not resemble a bladder tumor. Multidisciplinary approach with careful analysis of the imaging data suggested the diagnosis of osteochondroma. Open surgical excision of the mass was done and histology confirmed the diagnosis of benign osteochondroma. After 6 months of follow-up, the patient was still asymptomatic. Conclusions This case illustrates that hematuria is caused by not only urogenital disease but also osteochondroma. We present this case to draw the attention of clinicians to osteochondroma of the pubic symphysis.

scholarly journals Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

2016 ◽  
Vol 64 (2) ◽  
pp. 212-218
Author(s):  
Paulo de Camargo MORAES ◽  
Luiz Alexandre THOMAZ ◽  
Milena Bortolotto Felippe SILVA ◽  
José Luiz Cintra JUNQUEIRA ◽  
Rubens Gonçalves TEIXEIRA
Keyword(s):  
Conservative Management ◽  
Three Dimensional ◽  
Clinical Aspect ◽  
Dental Extraction ◽  
Review Of Literature ◽  
Nonoperative Therapy ◽  
Exposed Bone ◽  
Regular Review

ABSTRACT Osteoradionecrosis of jaws is one of the most serious complications of radiation therapy for head and neck malignancies. The management of osteoradionecrosis continues to be debated and there are few cases which can be resolved with conservative management. This paper presents a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man and highlights the conservative therapeutic management and 3-year follow-up period. We combined a conservative nonoperative therapy, including long-term antibiotic therapy and daily irrigation with chlorhexidine mouthrinses in a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man. At the follow-up, clinical aspect was resolved. A CBCT scan image and a three-dimensional (3D) reconstructed image revealed bone remodeling in a 3-year follow-up period .No sign of exposed bone could be seen. Follow-up 3 years later revealed that the conservative management posed was successful for osteoradionecrosis and the patient is currently under regular review.

scholarly journals Arthroscopic posterior-inferior capsular release in the treatment of overhead athlete with GHIRD: a case report

2018 ◽  
Vol 7 (1) ◽  
pp. 301
Author(s):  
Stedy Adnyana Christian ◽  
I. G. N. Wien Aryana ◽  
I. B. Aditya Wirakarna ◽  
I. G. B. Indra Angganugraha P. J. ◽  
Komang Arie Trysna Andika ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Nonoperative Treatment ◽  
Shoulder Function ◽  
Successful Outcome ◽  
Overhead Athletes ◽  
Capsular Release ◽  
Management Evaluation ◽  
Glenohumeral Internal Rotation Deficit ◽  
Pathologic Findings

Glenohumeral internal rotation deficit (GHIRD) is one of most controversial joint diseases in terms of diagnosis and treatment. The use of arthroscopy has improved the recognition of pathologic findings in glenohumeral internal rotation deficit (GHIRD) and allowed a better understanding of the etiology of it and the correlation between symptoms and lesion patterns. We present our technique for arthroscopic posterior-inferior capsular release in athlete with symptomatic glenohumeral internal rotation deficit (GIRD) that was unresponsive to nonoperative treatment and was preventing him from returning to sport. By this technique resulted in a successful outcome. We evaluate a 28 years old male with right shoulder pain and limitation in abduction internanal rotation after 3 months conservative treatment. We performed Arthrospcopic posterior-inferior capsular release. After 2 months correspondingly, we performed follow-up assessments on shoulder function (using the ases and rowe score) and pain (using a visual analogue scale) were made. Arthroscopic posterior-inferior capsular release can be recommended as a reasonable operative solution for overhead athletes with symptomatic GIRD that has not responden to conservative management. Evaluation of patient in whom we performed arthroscopic repair base on ases and rowe score. Arthroscopic posterior-inferior capsular release showed satisfactory shoulder function after 2 months follow up correspondingly.

The Surgical Treatment of Internal Snapping Hip

2002 ◽  
Vol 30 (4) ◽  
pp. 607-613 ◽  
Author(s):  
Gary S. Gruen ◽  
Thomas N. Scioscia ◽  
Jason E. Lowenstein
Keyword(s):  
Retrospective Cohort ◽  
Nonoperative Treatment ◽  
Iliopsoas Tendon ◽  
Ilioinguinal Approach ◽  
Nonoperative Therapy ◽  
Snapping Hip ◽  
Tendon Lengthening ◽  
Competitive Athletes ◽  
Viable Approach ◽  
Surgical Option

Background Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used. Hypothesis Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip. Study Design Retrospective cohort study. Methods In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years. Results All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery. Conclusion Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.

scholarly journals Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes

2018 ◽  
Vol 46 (5) ◽  
pp. 1129-1136 ◽  
Author(s):  
Daan T. van Yperen ◽  
Max Reijman ◽  
Eline M. van Es ◽  
Sita M.A. Bierma-Zeinstra ◽  
Duncan E. Meuffels
Keyword(s):  
Knee Osteoarthritis ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Nonoperative Treatment ◽  
Pivot Shift Test ◽  
Anterior Cruciate ◽  
High Level ◽  
Nonoperative Group

Background: An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear. Purpose: To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Fifty patients with an ACL rupture were eligible for participation, and they were treated either nonoperatively (n = 25) in 1992, consisting of structured rehabilitation and lifestyle adjustments, or operatively (n = 25) between 1994 and 1996 with an arthroscopic transtibial bone–patellar tendon–bone technique. The patients in the nonoperative group were drawn from those who responded well to 3 months of nonoperative treatment, whereas the patients in the operative group were drawn from those who had persistent instability after 3 months of nonoperative treatment. Both groups were pair-matched and assessed at 10- and 20-year follow-up regarding radiological knee osteoarthritis, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Tegner, Knee injury and Osteoarthritis Outcome Score), meniscal status, and knee stability (KT-1000 arthrometer, pivot-shift test, Lachman test, 1-legged hop test). Results: All 50 patients (100%) were included in the current study for follow-up. After 20 years, we found knee osteoarthritis in 80% of the operative group compared with 68% of the nonoperative group ( P = .508). There was no difference between groups regarding functional outcomes and meniscectomy performed. The median IKDC subjective score was 81.6 (interquartile range [IQR], 59.8-89.1) for the operative group and 78.2 (IQR, 61.5-92.0) for the nonoperative group ( P = .679). Regarding the IKDC objective score, 21 patients (84%) in the operative group had a normal or near normal score (A and B) compared with 5 patients (20%) in the nonoperative group ( P < .001). The pivot-shift test finding was negative in 17 patients (68%) versus 3 patients (13%) for the operative and nonoperative groups, respectively ( P < .001), and the Lachman test finding was negative in 12 patients (48%) versus 1 patient (4%), respectively ( P = .002). Conclusion: In this retrospective pair-matched follow-up study, we found that after 20-year follow-up, there was no difference in knee osteoarthritis between operative versus nonoperative treatment when treatment was allocated on the basis of a patient’s response to 3 months of nonoperative treatment. Although knee stability was better in the operative group, it did not result in better subjective and objective functional outcomes.

Endoscopic Resection of Different Types of Talocalcaneal Coalition

2018 ◽  
Vol 39 (9) ◽  
pp. 1082-1088 ◽  
Author(s):  
Wael Aldahshan ◽  
Adel Hamed ◽  
Faisal Elsherief ◽  
Ashraf Mohamed Abdelaziz
Keyword(s):  
Endoscopic Resection ◽  
Nonoperative Treatment ◽  
Level Of Evidence ◽  
Vas Score ◽  
Talocalcaneal Coalition ◽  
Short Term Study ◽  
Different Types ◽  
The Mean ◽  
American Orthopaedic

Background: The purpose of this study was to describe the technique of endoscopic resection of talocalcaneal coalition (TCC) by using 2 posterior portals and to report the outcomes of endoscopic resection of different types and sites of TCC. Methods: An interventional prospective study was conducted on 20 feet in 18 consecutive patients who were diagnosed by computed tomography to have TCC for which nonoperative treatment had failed and endoscopic resection was performed. The patients were divided into groups according to the site of the coalition (middle facet or posterior facet) and according to type (fibrous, cartilage, or bony). The mean follow-up period was 26 months (range, 6-36). Results: The average preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 57.7 (range, 40-65), and the average preoperative visual analog scale (VAS) score was 7.8 (range, 6-8). The average postoperative AOFAS hindfoot score was 92.4 (range, 85-98; P < .01). The average postoperative VAS score was 2.4 (range, 1-4). All patients showed no recurrence on postoperative lateral and Harris-Beath X-ray until the end of the study. Conclusions: Endoscopic resection of TCC was an effective and useful method for the treatment of talocalcaneal coalition. It provided excellent outcomes with no recurrence in this short-term study. Resection of the fibrous type had a better outcome than resection of cartilage and bony types. Endoscopic resection of the posterior coalition had a better outcome than resection of the middle coalition. Level of Evidence: Level III, comparative study.

Effectiveness of Compressive External Bracing in Patients with Flexible Pectus Carinatum Deformity: A Review

2019 ◽  
Vol 68 (01) ◽  
pp. 072-079
Author(s):  
Ian Hunt ◽  
Akshay Jatin Patel
Keyword(s):  
Chest Wall ◽  
Dynamic Compression ◽  
Young Patients ◽  
Dropout Rate ◽  
Nonoperative Treatment ◽  
Pectus Carinatum ◽  
Duration Of Treatment ◽  
Long Term Follow Up ◽  
Level I

AbstractThere has been a growing interest in the nonoperative treatment of chest wall deformities over the last few decades; with the advent of external compressive orthotics, similar outcomes have been reported compared with surgical intervention. There have been fewer major complications reported with dynamic compression bracing on the chest wall; however, the Achilles heel of this approach still lies with treatment tolerability and compliance. A Medline literature search was undertaken to evaluate the evidence concerning the techniques, modifications, and outcomes associated with external compressive bracing in the setting of pectus carinatum. Sixteen articles were integrated after literature review and data were collected on methods of assessing pectus carinatum (degree of severity as well as type), patient selection protocol (i.e., suitability for external compressive bracing), the bracing protocol itself, duration of treatment, metrics used to assess outcome, and success, compliance, and dropout rate, and length of long-term follow-up. Compressive external bracing appears to be a safe and well tolerated nonsurgical treatment option for young patients with flexible pectus carinatum deformities. However, there is still a need for robust level I randomized data from multiple centers with a clearly standardized bracing protocol, objective measurement of outcomes, and recording of results at the end of the bracing treatment program in sufficiently powered sample sizes over a significant follow-up period.

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