Updated: 6/1/2021

Adductor Strain

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Questions
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Evidence
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Cases
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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.
Flashcards (1)
Cards
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Questions (2)

(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?

QID: 8881
FIGURES:
1

Activity modification and NSAIDs

52%

(1573/3020)

2

Antibiotics

1%

(25/3020)

3

Irrigation and debridement

3%

(76/3020)

4

Prophylactic fixation

3%

(87/3020)

5

Biopsy

41%

(1238/3020)

L 3 B

Select Answer to see Preferred Response

(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?

QID: 1413
1

Strict immobilization with the leg in flexion and adduction

7%

(172/2425)

2

Immediate rehabilitation consisting of increasing passive and active motion

71%

(1726/2425)

3

Tendon repair

16%

(380/2425)

4

Tendon tenodesis

4%

(89/2425)

5

Tendon repair with adjunctive allograft reconstruction

2%

(51/2425)

L 3 D

Select Answer to see Preferred Response

Evidence (4)
CASES (1)
EXPERT COMMENTS (4)
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