Demographic features:
(1) Males are more often affected than women.
(2) It tends to be more common in middle aged adults.
(3) The condition tends to last for months to years.
(4) It may be recurrent if poorly managed or if the precipitating cause (pregnancy, etc.) is repeated.
Clinical findings:
(1) gradual or acute onset of discomfort or pain
(1a) in the pubic area
(1b) one or both groins (adductor areas)
(1c) lower rectus abdominis muscle
(1d) perineum (and scrotum in men)
(2) aggravation on movements of the lower extremity (running, kicking, walking, etc.)
(3) sensation of clicking in the pubis when turning over in bed, standing up from a sitting position or walking on uneven ground
(4) tenderness over the symphysis pubis and adjacent pubic bodies
(5) pain on stretching the adductor muscles
(6) stiffness with decreased range of motion in one or both hips
(7) sacroiliac joint dysfunction
Imaging studies:
(1) positive 99m-Technetium (99mTc) bone scan
(2) Radiographic changes in the bone are often absent in mild disease but are often present in more severe disease. Instability of the symphysis pubis may be seen if the person stands on one leg ("flamingo" views).
Laboratory findings:
(1) variable elevation in the ESR (most often when associated with a rheumatologic disorder)
(2) cultures negative
Differential diagnosis:
(1) stress fracture
(2) osteomyelitis
(3) pelvic infection
