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Symphyseal Cleft Injection in the Diagnosis and Treatment of Osteitis Pubis in Athletes

¹ Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
² Department of Radiology, Mater Misericordiae Hospital, Eccles St., Dublin 7, Ireland.

View larger version (172K): [in a new window]   Fig. 1. —22-year-old male athlete with osteitis pubis. Coronal T1-weighted MR image (TR/TE, 620/20) shows irregularity in joint surface and fatty replacement of paraarticular marrow (straight arrow). Note superior extrusion of fibrocartilaginous disk indenting bladder (curved arrow).

View larger version (147K): [in a new window]   Fig. 2. —26-year-old male soccer player with osteitis pubis. Axial T2-weighted MR image (TR/TE, 2000/80) shows paraarticular marrow edema, joint surface irregularity, and posterior extrusion of the fibrocartilaginous disk (arrow).

View larger version (162K): [in a new window]   Fig. 3. —32-year-old male football player with groin pain. Coronal turbo short tau inversion recovery MR image (TR/TE, 2000/20; inversion time, 160 msec) shows extensive parasymphyseal marrow edema that is consistent with osteitis pubis. Marginal osteophyte (arrow) can be seen indenting bladder.

View larger version (139K): [in a new window]   Fig. 4. —19-year-old male athlete with osteitis pubis. Anteroposterior radiograph shows normal findings after symphyseal cleft injection. Contrast material is confined to central cleft of fibrocartilaginous disk with no evidence of extrusion. Sclerosis and marginal osteophyte (arrow) are seen on medial margins of pubic bones.

View larger version (122K): [in a new window]   Fig. 5. —31-year-old male rugby player with groin pain. Symphysogram shows extravasation of contrast material superiorly (straight arrow) and inferiorly that results from loss of disk morphology. Inferiorly, contrast material tracks into insertion of right gracilis muscle (curved arrow), indicating chronic avulsion injury at this site.

View larger version (136K): [in a new window]   Fig. 6. —35-year-old male soccer player with severe groin pain. Digital radiograph obtained after symphyseal cleft injection shows considerable joint disruption with marginal osteophyte formation. Paraarticular venous intravasation (arrow) is visible. This finding is thought to relate to hypervascularity associated with inflammatory osteitis pubis.

View larger version (102K): [in a new window]   Fig. 7. —29-year-old male soccer player. Anteroposterior radiograph shows extensive erosive changes of osteitis pubis and widening of joint space (arrow).

View larger version (111K): [in a new window]   Fig. 8. —22-year-old man with osteitis pubis. 99mTc-methyl diphosphonate—enhanced scintigram shows markedly increased radionuclide uptake on medial margins of pubic bones (arrows).

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