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Introduction
  • A common injury to the adductor muscle group
  • Epidemiology
    • incidence
      • occurs in 10-30% of soccer and hockey players due to strong eccentric contraction of adductors during play
  • Pathophysiology
    • mechanism
      • a “pulled groin,” is caused by forceful external rotation of an abducted leg.
Classification
  • 1st degree
    • pain with minimal loss of strength and motion
  • 2nd degree
    • compromised strength
  • 3rd degree
    • complete disruption with loss of muscle function
Anatomy
  • Hip joint adductor complex
    • adductor longus  (most common muscle injured in complex)
    • adductor magnus
    • adductor brevis
    • gracilis
    • obturator externus
    • pectineus
  • All have obturator nerve innervation
Presentation
  • Symptoms
    • pain is immediate and severe in the groin region.
  • Physical exam
    • tenderness is at the site of injury along the subcutaneous border of the pubic ramus. 
    • pain and/or decreased strength with resisted leg adduction compared to the other leg
Imaging
  • Radiographs
    • recommended views
      • AP pelvis
      • lateral of hip
    • findings
      • if injury is due to an avulsion then fleck of bone may be visible
  • MRI
    • may show avulsion injury of the adductor muscle from the pubic ramus with muscle edema and hemorrhage.
Treatment
  • Nonoperative
    • rest, ice, protected weight bearing as needed 
      • indications
        • mainstay of treatment
      • modalities
        • dictated by the severity of the symptoms but generally consists of of a period of rest 
          • follow with a rehabilitation program that begins with gentle stretching and progresses to resistance exercise and core strengthening with a gradual return to sports 
          • immobilization should be avoided because this promotes muscle tightness and scarring
  • Operative
    • open repair
      • indications
        • no data exist to suggest that open repair yields a better outcome than nonsurgical management. 
 

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