Painful pubic joint instability is the main indication of selective steroid injection of the pubic symphysis. It occurs mainly in multiparae (Fig. 16). It is however wise to first rule out pubic

joint infection. Pubic joint infection may complicate intrapelvic surgery or interventional procedure, as well as delivery or abortion. A spontaneously abortive pubic joint infection might be the first step of chronic pubic joint instability, because both diseases share the same radiological changes with subchondral bone erosion and joint space widening. In some cases, however, changes due to infection may be rapidly progressive on plain films or CT examinations. A soft tissue mass at CT or MR examinations would also help recognize infection. Finally, it is sometimes necessary to obtain bacteriological and pathological studies of pubic joint lavage or pubic subchondral bone samples prior to injecting steroid into pubic symphysis.

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Dealing With Back Pain

Dealing With Back Pain

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