Updated: 2/28/2020

Adductor Strain

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Questions
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Evidence
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Cases
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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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Average 3.9 of 14 Ratings

Questions (2)

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(OBQ16.119) A 17-year-old male football player presents with a 3-week history of insidious right thigh pain and a limp. He denies any history of trauma. He is afebrile and WBC, ESR, and CRP are within normal limits. On examination he has pain with resisted adduction of his right hip only. The remainder of the examination is normal. Imaging obtained is shown in figures A, B, and C. What is the next best step in treatment? Review Topic | Tested Concept

QID: 8881
FIGURES:
1

Activity modification and NSAIDs

50%

(1230/2458)

2

Antibiotics

1%

(22/2458)

3

Irrigation and debridement

2%

(60/2458)

4

Prophylactic fixation

3%

(73/2458)

5

Biopsy

43%

(1055/2458)

L 3 D

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(SBQ07SM.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 | Tested Concept

QID: 1413
1

Strict immobilization with the leg in flexion and adduction

6%

(139/2151)

2

Immediate rehabilitation consisting of increasing passive and active motion

72%

(1554/2151)

3

Tendon repair

16%

(335/2151)

4

Tendon tenodesis

3%

(69/2151)

5

Tendon repair with adjunctive allograft reconstruction

2%

(48/2151)

L 3 D

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Evidences (4)
CASES (1)
Topic COMMENTS (4)
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