summary Osteitis pubis is the inflammation of the pubic symphysis caused by repetitive trauma that most commonly occurs during sports involving repetitive kicking or hip abduction/adduction. Diagnosis is made clinically with localized pain over the pubic symphysis with radiographs showing osteolytic pubis with bony erosions and often times diastasis of the symphysis. Treatment is nonoperative with rest, NSAIDs and activity modification. Epidemiology Demographics common in soccer, hockey, football and running Etiology Pathophysiology mechanism repetitive microtrauma to the pubic symphysis by sports involving repetitive kicking sports involving hip repetitive adduction/abduction Anatomy Pubic symphysis osteology located at the anterior articulation between each hemipelvis composed of articular cartilage-covered rami separated by fibrocartilage disc muscles regional attachments adductors adductor magnus adductor brevis adductor longus gracilis rectus abdominis pectineus ligaments superior pubic ligament inferior pubic ligament anterior pubic ligament posterior pubic ligament biomechanics very stable joint strong ligamentous support limits motion Presentation Symptoms vague, ill-defined pain is anterior pelvic region worse with activities involving hip adduction/abduction at the anterior pelvis may have spasms with hip adduction Physical exam palpation localized tenderness directly over the pubic symphysis Imaging Radiographs recommended views AP of pelvis findings AP pelvis shows osteolytic pubis with bony erosions and often times diastasis of the symphysis degenerative changes within the joint can be seen MRI bone marrow edema found early Bone scan increased activity in area of pubic symphysis Differential Athletic pubalgia Stress fracture of the pubic rami Stress fracture of the femoral neck Inguinal hernia Oncologic disease (rare) Treatment Nonoperative NSAIDS, rest, activity modification indications treatment for vast majority of cases modalities steroid injections are controversial outcomes self-limiting process which usually resolves with non-operative treatment may take several months to resolve