Osteitis pubis.

BACKGROUND A 55-year-old woman was seen for pubic symphysis tenderness that started 3 weeks after bladder suspension surgery for urinary incontinence. A diagnosis of osteitis pubis was made based on the results of the physical, radiographic, and laboratory examinations. The paucity of information on this topic in primary care textbooks prompted a literature review of the subject. METHODS A computer-assisted literature search of the MEDLINE files from 1966 to the present was performed using the terms "osteitis," "osteomyelitis," and "pubic symphysis." Older documents and papers of related interest were obtained by cross-reference of the bibliographies of the articles generated by the search. RESULTS AND CONCLUSIONS Osteitis pubis is an infrequent complication of pelvic surgery, parturition, or athletic activities. The diagnosis is made on the basis of the typical findings of pubic tenderness and pain on hip abduction that occurs a few weeks following the inciting event. Initial treatment consists of rest, physical therapy, and oral nonsteroidal or glucocorticoid anti-inflammatory medications. The use of intra-articular glucocorticoid injections is controversial. Surgery is rarely indicated and should be reserved for patients who have severe pain or pubic instability that has not responded to conservative therapy.