A patient, aged 45 years, presented to the office with a 5 year history of lower back and pelvic pain. The pain started a few months after childbirth.
The pain increased and the patient reported feeling muscle weakness in the groin while walking. She denied any numbness or tingling in the lower extremities.
On exam, compression of the pelvis caused referred back pain. Distal pulses were 2+ and motor strength was intact in bilateral lower extremities.
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The symphysis pubis is a stiff fibrocartilaginous joint that joins the two sides of the hemipelvis. The average gap between the bones of the symphysis pubis is approximately 5 mm.
During pregnancy, the pelvic muscles relax and the symphysis pubis can widen by 2 to 3 mm. A widening of 10 mm or more on anteroposterior (AP) pelvis x-ray is diagnostic of symphysis pubis dysfunction.
The symphysis pubis widening of more than than 3 cm in this patient indicates an unstable diastasis symphysis pubis.
Dagan Cloutier, MPAS, PA-C, practices in a multispeciality orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Buckolz RW, Heckman JD, Court-Brown C. Rockwood and Green’s Fractures in Adults. 6th edition. Philadelphia, PA. 2006.