Pelvis / Coccyx
Pubic Symphysis Dysfunction
치골결합 기능장애
Pregnancy-related symphyseal laxity and pain (pelvic girdle pain)
- How common
- 20–30% of pregnancies
- Typical age
- Pregnant/postpartum women
What is it?
Relaxin softens ligaments while uterine weight and postural changes overload the symphysis, producing pain.
Commonly affected: Pubic symphysis and bilateral SI joints
How it develops
- Hormonal ChangesRelaxin/estrogen soften ligaments
- Symphyseal LaxityJoint widening (up to >10mm)
- Mechanical InstabilityAsymmetric motion with weight shift
- Pain/DysfunctionWalking, single-leg stance, rolling in bed aggravate pain
Symptoms
- Anterior pubic painSplitting pain over symphysis
- Worse with walkingWaddling gait
- Pain single-leg stanceDifficulty with stairs, dressing
- Pain turning in bedBed mobility painful
- Pubic clickingAudible/palpable click with motion
How it is examined
- Symphysis tendernessDirect tenderness over symphysis
- Trendelenburg signContralateral pelvic drop on single-leg stance
- Active straight-leg raiseDifficulty/pain lifting straight leg supine
- FABER testReproduces SI/pubic pain
Imaging
Avoid during pregnancy; postpartum AP pelvis and flamingo view assess instability.
- Symphysis widening (>10mm)
- Superior/inferior offset (>2mm)
- Flamingo view dynamic instability
- For postpartum assessment
Safe in pregnancy; evaluates edema, effusion, microinjury.
- Symphyseal edema (STIR)
- Joint effusion
- Peri-articular muscle/tendon edema
- Possible microtear
Non-surgical care
- Pelvic support beltSymphyseal stabilization belt
- Activity mod/postureAvoid asymmetric loads; keep knees together
- PT / pelvic floorCore, pelvic floor, glute strengthening
- Safe analgesicsAcetaminophen, ice/heat therapy
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Persistent postpartum instability or diastasis >25mm
Procedures that may be discussed
- External fixation (emergent)
- Open reduction internal fixation (ORIF)
- Symphyseal arthrodesis
Outlook
Most resolve within 3–6 months postpartum; 20% have persistent symptoms.