Adductor Strain

DISCUSSION: 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.