Symphysis Pubis Separation
Overview:
Causes/Risk Factors/Pathogenesis:
Contraindications/Precautions:
Examination:
--History
--Diagnostic Tests/Imaging/Tests and Measures
Assessment/Outcome Measures:
Clinical Bottom Line:
Asses the need for medical management and refer as necessary. When treating: pain reduction for acute injuries should be the early focus, patient education about limiting aggravating activities until healed, improve hip range of motion, improve hip strength.
See the Symphysis Pubis Separation References
- A sustained symphyseal widening due to trauma, ligament laxity, or avulsion fractures
- The threshold of pathological separation is varied, ranging from 6 mm to 10 mm; and is identified based on whether the patient is experiencing symptoms from the separation
Causes/Risk Factors/Pathogenesis:
- Symphysis pubis separation can be caused by trauma, typically following a very high velocity force. It has been associated with horseback riding injuries, and other high impact sports (football, hockey, rugby),particularly in patients with inflammatory arthritis following long-term corticosteroid use
- Size of the separation is not predictive of the clinical course. Although symphysis pubis widening is associated with pain, there is no evidence that the
amount of widening is related to the severity of the pain
Contraindications/Precautions:
- Patients with symphysis pubis separation should limit weight-bearing and ambulation as much as possible until the separation has reduced.
- Abduction of the hips should be avoided to prevent further separation or rupture.
- The use of pelvic binders, as prescribed, is also extremely important in the correction of symphysis pubis separation
Examination:
--History
- Subjective exam focusing on causes/events leading up to injury
- Severity of symptoms; along with description, aggravating/easing factors
--Diagnostic Tests/Imaging/Tests and Measures
- Pubis symphysis palpation for pain and edema
- VAS pain scale
- Hip PROM/AROM
- Hip muscle strength testing
- X-rays or MRI to assess degree of separation
- FABER -- Watch Video
Assessment/Outcome Measures:
- Gait assesssment
- Symmetry/Asymmetry of the pelvis
- Spinal curvature and bony landmarks
Clinical Bottom Line:
Asses the need for medical management and refer as necessary. When treating: pain reduction for acute injuries should be the early focus, patient education about limiting aggravating activities until healed, improve hip range of motion, improve hip strength.
See the Symphysis Pubis Separation References