Pubic symphysis diastasis: Difference between revisions
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==Mechanism == |
==Mechanism == |
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A specific cause for the separation of the pubic symphysis during pregnancy and delivery has not been identified by researchers as of date. Thoughts surrounding the hormone relaxin and its effect on the laxity of ligaments during pregnancy have been investigated, but no direct cause of this hormone to pubic symphysis diastasis has been identified. Relaxin, in conjunction with progesterone, can cause a physiological separation of the pubic symphysis during pregnancy that typically measures 3-5mm and is most pronounced in the first trimester and returns to normal size within 5 months postpartum |
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Risk factors associated with the condition have been identified and include cephalopelvic disproportion, large fetuses, epidural anesthesia, the use of forceps, primigravida, multiple gestations, and previous pre-existing pelvic injury or pathology. Risk factors related diastasis of the pubic symphysis can further be stratified by causes including enzymatic causes such as disturbances in collage synthesis, endocrine causes related to hormones produced in pregnancy such as progesterone, estrogen and relaxin, inflammatory processes, metabolic disturbances in the production of vitamin D and calcium and pelvic instability such as congenital malformations and excessive lumbar lordosis. |
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In addition, outside of pregnancy and post-partum states, separation of the pubic symphysis can be seen in the setting of trauma. These cases are related to injuries sustained from high velocity injuries such as motor vehical accidents, falls from large heights, falling from a horse and crush injuries <ref>{{Cite journal |last=Williamson |first=Michael |last2=Vanacore |first2=Felice |last3=Hing |first3=Caroline |date=2018-06 |title=Pubic symphysis diastasis sustained from a waterslide injury |url=https://linkinghub.elsevier.com/retrieve/pii/S0976566217304666 |journal=Journal of Clinical Orthopaedics and Trauma |language=en |volume=9 |pages=S32–S34 |doi=10.1016/j.jcot.2018.01.002 |pmc=6008670 |pmid=29928101}}</ref> |
In addition, outside of pregnancy and post-partum states, separation of the pubic symphysis can be seen in the setting of trauma. These cases are related to injuries sustained from high velocity injuries such as motor vehical accidents, falls from large heights, falling from a horse and crush injuries <ref>{{Cite journal |last=Williamson |first=Michael |last2=Vanacore |first2=Felice |last3=Hing |first3=Caroline |date=2018-06 |title=Pubic symphysis diastasis sustained from a waterslide injury |url=https://linkinghub.elsevier.com/retrieve/pii/S0976566217304666 |journal=Journal of Clinical Orthopaedics and Trauma |language=en |volume=9 |pages=S32–S34 |doi=10.1016/j.jcot.2018.01.002 |pmc=6008670 |pmid=29928101}}</ref> |
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Revision as of 18:10, 8 March 2022
| Diastasis symphysis pubis | |
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| Post traumatic diastasis of symphysis pubis | |
| Specialty | Orthopaedic |
Diastasis symphysis pubis is the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture that measures radiologically more than 10 mm. Separation of the symphysis pubis is a rare pathology associated with child birth and has an incidence of 1 in 300 to 1 in 30,000 births. It is usually noticed after delivery but can be observed up to 6 months postpartum.[1] Risk factors associated with this injury include cephalopelvic disproportion, rapid second stage of labor, epidural anesthesia, severe abduction of the thighs during delivery or previous trauma to the pelvis. Common signs and symptoms include symphyseal pain aggravated by weight bearing and walking, a waddling gait, pubic tenderness, and a palpable interpubic gap. Treatment for diastases symphysis pubis is largely conservative, with treatment modalities including pelvic bracing, bed rest, analgesia, physical therapy and in some severe cases, surgical.[2]
Mechanism
A specific cause for the separation of the pubic symphysis during pregnancy and delivery has not been identified by researchers as of date. Thoughts surrounding the hormone relaxin and its effect on the laxity of ligaments during pregnancy have been investigated, but no direct cause of this hormone to pubic symphysis diastasis has been identified. Relaxin, in conjunction with progesterone, can cause a physiological separation of the pubic symphysis during pregnancy that typically measures 3-5mm and is most pronounced in the first trimester and returns to normal size within 5 months postpartum
Risk factors associated with the condition have been identified and include cephalopelvic disproportion, large fetuses, epidural anesthesia, the use of forceps, primigravida, multiple gestations, and previous pre-existing pelvic injury or pathology. Risk factors related diastasis of the pubic symphysis can further be stratified by causes including enzymatic causes such as disturbances in collage synthesis, endocrine causes related to hormones produced in pregnancy such as progesterone, estrogen and relaxin, inflammatory processes, metabolic disturbances in the production of vitamin D and calcium and pelvic instability such as congenital malformations and excessive lumbar lordosis.
In addition, outside of pregnancy and post-partum states, separation of the pubic symphysis can be seen in the setting of trauma. These cases are related to injuries sustained from high velocity injuries such as motor vehical accidents, falls from large heights, falling from a horse and crush injuries [3]
Diagnosis
This abnormally wide gap can be diagnosed by radiologic studies such as X-ray, MRI, CT scan or bone scan. Manual testing by a healthcare professional can also be used. The patient is placed in various positions and pressure is applied in such a way that it provokes pain and maybe movement in the pubis.[citation needed]
Differential diagnosis
- In bladder extrophy[4] there is a gap between the pubis, which are joined by a strong interpubic ligament.
X-ray
An X-ray film will show a marked gap between the pubic bones, normally there is a 4–5 mm gap but in pregnancy, hormonal influences cause relaxation of the connecting ligaments and the bones separate up to 9 mm. To demonstrate instability of the joint the patient is required to stand in the "flamingo" position, (standing with weight on one leg and the other bent).[5] A vertical displacement of more than 1 cm is an indicator of symphysis pubis instability.[6] A displacement of more than 2 cm usually indicates involvement of the sacroiliac joints.[citation needed]
CT scan and MRI
Both diagnostic machines can produce detailed cross sections of the pelvic area. Images will show degrees soft tissue injury, inflammation of the subchondral region and the bone marrow [7] and any abnormal posturing of the pelvic joints.
Bone scan
A bone scan is able to determine areas of bone inflammation.[citation needed]
Management
Treatment include bed rest, anti inflammatory agents, physiotherapy and a pelvic corset to provide support and stability.[citation needed]
References
- ^ Herren, C.; Sobottke, R.; Dadgar, A.; Ringe, M.J.; Graf, M.; Keller, K.; Eysel, P.; Mallmann, P.; Siewe, J. (2015-06). "Peripartum pubic symphysis separation – Current strategies in diagnosis and therapy and presentation of two cases". Injury. 46 (6): 1074–1080. doi:10.1016/j.injury.2015.02.030.
{{cite journal}}: Check date values in:|date=(help) - ^ Urraca-Gesto, M. Alicia; Plaza-Manzano, Gustavo; Ferragut-Garcías, Alejandro; Pecos-Martín, Daniel; Gallego-Izquierdo, Tomás; Romero-Franco, Natalia (2015). "Diastasis of symphysis pubis and labor: Systematic review" (PDF). Journal of Rehabilitation Research and Development. 52 (6): 629–640. doi:10.1682/JRRD.2014.12.0302. ISSN 0748-7711.
- ^ Williamson, Michael; Vanacore, Felice; Hing, Caroline (2018-06). "Pubic symphysis diastasis sustained from a waterslide injury". Journal of Clinical Orthopaedics and Trauma. 9: S32–S34. doi:10.1016/j.jcot.2018.01.002. PMC 6008670. PMID 29928101.
{{cite journal}}: Check date values in:|date=(help) - ^ http://www.bartleby.com/107/255.html (end of page)
- ^ An Analysis of Pubis Symphysis Misalignment Using Plain Film Radiography Ruch WJ, Ruch BM. J Manipulative Physiol Ther. 2005;28(5):330-335
- ^ Vertically Unstable Pelvic Fractures Fixed with Percutaneous Iliosacral Screws: Does Posterior Injury Predict Fixation Failure? Damian R. Griffin, MA, FRCS (Orth); Adam J. Starr, MD; Charles M. Reinert, MD; Alan L. Jones, MD; Shelly Whitlock, CCRA; University of Texas Southwestern Medical Center, Dallas, TX
- ^ Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: inter-reader reliability and prevalence of abnormalities. Arthritis Research & Therapy 2006, 8:R11 doi:10.1186/ar1859. Liesbeth Heuft-Dorenbosch1, René Weijers, Robert Landewé1, Sjef van der Linden1, Désirée van der Heijde1
External links
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