Pubic Symphysis Dysfunction: Difference between revisions
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== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<br> == | ||
Aslan et al. say that the aetology of SPD is unknown.<ref name="19" /> Pregnancy leads to an altered pelvic load, lax ligaments and weaker musculature. This leads to spino-pelvic instability, which manifest itself as symphysis pubic dysfunction.<ref name="3" /><ref name="5">Coldron Y. Margie Poldon Memorial lecture: ‘Mind the gap!’Symphysis pubis dysfunction revisited. Journal of the Association of Chartered Physiotherapists in Women’s Health 2005;96:3–15.</ref><br>In early stages of the pregnancy the corpus luteum secretes a lot of relaxin and progesteron.<ref name="3" /> From the 12th week of the pregnancy this function is continued by the placenta and decidua.<ref name="3" /> Relaxin breaks down collagen in the pelvic joint and causes laity and softening. Progesterone has a similar effect. But relaxin has no correlation with the degree of symptoms of symphysis pubic dysfunction.<ref name="3" /><ref name="6">Bjorklund K, et al., Symphyseal distension in relation to serum relaxin levels and pelvic pain in pregnancy. Acta Obstet Gynecol Scan 2000;79:269–75.</ref><ref name="17">Ohtera K. et al., Effect of pregnancy on joint contracture in the rat knee, J Appl Physiol 92,2002, 1494-1498.</ref> A Norwegian study showed that genetic susceptibility to joint dysfunction is possibly caused by an aberration of relaxine.<ref name="7">MacLennan AH, MacLennan SC., Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and development dysplasia of the hip., Acta Obstet Gynecol Scand, 1997;76:760–64.</ref> It would seem that the presence of laxity as the result of a hormonal link is undisputed.<ref name="3" /> However there is no full disclosure for this. <br><br> | Aslan et al. say that the aetology of SPD is unknown.<ref name="19" /> Pregnancy leads to an altered pelvic load, lax ligaments and weaker musculature. This leads to spino-pelvic instability, which manifest itself as symphysis pubic dysfunction.<ref name="3" /><ref name="5">Coldron Y. Margie Poldon Memorial lecture: ‘Mind the gap!’Symphysis pubis dysfunction revisited. Journal of the Association of Chartered Physiotherapists in Women’s Health 2005;96:3–15.</ref> | ||
<br>In early stages of the pregnancy the corpus luteum secretes a lot of relaxin and progesteron.<ref name="3" /> From the 12th week of the pregnancy this function is continued by the placenta and decidua.<ref name="3" /> Relaxin breaks down collagen in the pelvic joint and causes laity and softening. Progesterone has a similar effect. But relaxin has no correlation with the degree of symptoms of symphysis pubic dysfunction.<ref name="3" /><ref name="6">Bjorklund K, et al., Symphyseal distension in relation to serum relaxin levels and pelvic pain in pregnancy. Acta Obstet Gynecol Scan 2000;79:269–75.</ref><ref name="17">Ohtera K. et al., Effect of pregnancy on joint contracture in the rat knee, J Appl Physiol 92,2002, 1494-1498.</ref> A Norwegian study showed that genetic susceptibility to joint dysfunction is possibly caused by an aberration of relaxine.<ref name="7">MacLennan AH, MacLennan SC., Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and development dysplasia of the hip., Acta Obstet Gynecol Scand, 1997;76:760–64.</ref> It would seem that the presence of laxity as the result of a hormonal link is undisputed.<ref name="3" /> However there is no full disclosure for this. <br><br> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
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Clinically Relevant Anatomy
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We can find the symphysis pubic on the anterior side of the pelvis. It’s also the anterior boundary of the perineum.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In cooperation with the illio-sacral joints the symphysis forms a stable pelvic ring. This ring allows only some small mobility.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The pubic symphysis is a cartilagenous joint which consists of a fibrocartilagneous interpubic disc Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title(which had transversal and helical fibers) and the surrounding ligaments uniting the bodies of the pubic bones in the median plane. With children this disc is very small and the hyaline cartilage is very wide. But it evolves conversely.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title With men the disc is higher, smaller and narrower.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Normally with women the symphysis pubic gap is 4-5 mm wide and it widens 2-3 mm during the last trimester of pregnancy. This is necessary to facilitate the delivery of the fetus.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In symphysis pubis dysfunction the joints become more relaxed and allow instability in the pelvic girdle. When the gap is equal to or more than 10 mm there’s a diastasis of the symphysis pubic.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Mechanism of Injury / Pathological Process
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Aslan et al. say that the aetology of SPD is unknown.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Pregnancy leads to an altered pelvic load, lax ligaments and weaker musculature. This leads to spino-pelvic instability, which manifest itself as symphysis pubic dysfunction.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
In early stages of the pregnancy the corpus luteum secretes a lot of relaxin and progesteron.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title From the 12th week of the pregnancy this function is continued by the placenta and decidua.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Relaxin breaks down collagen in the pelvic joint and causes laity and softening. Progesterone has a similar effect. But relaxin has no correlation with the degree of symptoms of symphysis pubic dysfunction.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title A Norwegian study showed that genetic susceptibility to joint dysfunction is possibly caused by an aberration of relaxine.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title It would seem that the presence of laxity as the result of a hormonal link is undisputed.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title However there is no full disclosure for this.
Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions
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Differential Diagnosis
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