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Updated: Jun 1 2021

Adductor Strain

4.1

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  • summary
    • An adductor strain is a common injury to the adductor muscle group that occurs as a result of forceful hip extension & external rotation of an abducted leg.
    • Diagnosis is made clinically with groin pain with tenderness over the inferior pubic rami and decreased strength with resisted leg adduction compared to the other leg.
    • Treatment is nonoperative with rest, NSAIDs and protected weight bearing. 
  • Epidemiology
    • Incidence
      • occurs in 10-30% of soccer and hockey players 
  • Pathophysiology
    • Mechanism
      • a “pulled groin,” is caused by forceful hip extension & external rotation of an abducted leg.
      • Occurs due to strong eccentric contraction of adductors during play
  • Classification
      • Adductor strain 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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