• 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.
  • 1st degree
    • pain with minimal loss of strength and motion
  • 2nd degree
    • compromised strength
  • 3rd degree
    • complete disruption with loss of muscle function
  • 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
  • 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
  • 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.
  • 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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Questions (1)

(SBQ07.28) 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? Review Topic


Strict immobilization with the leg in flexion and adduction




Immediate rehabilitation consisting of increasing passive and active motion




Tendon repair




Tendon tenodesis




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.


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