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A professional rugby player has acute groin pain after an awkward collision with an opponent. MRI shows an avulsion injury of his adductor muscle. Which of the following is an appropriate treatment to provide?
Strict immobilization with the leg in flexion and adduction
Immediate rehabilitation consisting of increasing passive and active motion
Tendon repair with adjunctive allograft reconstruction
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Adductor muscle avulsions are caused by muscle failure in tension as the leg is abducted. Symptoms are localized to the groin along the medial aspect of the pubic ramus. Treatment based on rest, ice, and mobilization with protected weight bearing is recommended to avoid muscle scarring and contractures. Muscle rehabilitation should include progressive gentle range of motion, followed by progressive active muscle strengthening. There is no high level evidence that surgical repair of adductor strains yields better outcomes than nonsurgical management.
Gilmore provides a review of groin pain that occurs commonly in soccer athletes. Causes of such groin injuries include: muscle injuries such as adductor strains, direct trauma, osteitis pubis, fractures, bursitis, hip problems, hernia and referred pain.
Irshad et al discusses the "hockey groin syndrome," marked by tearing of the external oblique aponeurosis and entrapment of the ilioinguinal nerve, which is a cause of groin pain in professional hockey players. They recommend ilioinguinal nerve ablation and reinforcement of the external oblique aponeurosis for treatment of this injury.
Illustration A shows a T2 pelvic MRI with a left sided adductor tear, evidenced by the increased fluid signal. Arrow 1 points to the tendon origin on the pubic rami, and arrow 2 is pointing to the avulsed adductor tendon.
Clin Sports Med. 1998 Oct;17(4):787-93, vii. PMID: 9922902 (Link to Abstract)
Irshad K, Feldman LS, Lavoie C, Lacroix VJ, Mulder DS, Brown RA.
Surgery. 2001 Oct;130(4):759-64; discussion 764-6. PMID: 11602909 (Link to Abstract)
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HPI - Patient with pain in his groin for 6 months. He has abnormal gait pattern. Pain on his groin when adducting his thigh with a bump. He had done physical therapy with poor results.
What is the best treatment?