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Adductor Strain Clinical Presentation

  • Author: Marlon P Rimando, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Feb 10, 2016
 

History

Generally, symptoms are more diffuse, with typical complaints of pain and stiffness in the groin region in the morning and at the beginning of athletic activity. Initial intense pain lasts less than a second. This initial pain is soon replaced with an intense dull ache. Pain severity can vary with different patients. Pain and stiffness often resolve after a period of warming up but often recur after athletic activity.

Typical findings include tenderness at the origin of the adductor longus and/or the gracilis located at the inferior pubic ramus and pain with resisted adduction. Groin pain can represent a number of different diagnoses, and all differential diagnoses should be kept in mind when assessing the patient. Obtain information about the mechanism of injury and loss of function, as well as about the location, quality, duration, and severity of pain. The aggravating and alleviating factors also should be noted.

Usually, pain is described at the site of the adductor longus tendon proximally, especially with rapid adduction of the thigh. As the injury becomes more chronic, pain may radiate distally along the medial aspect of the thigh and/or proximally toward the rectus abdominis. Acute injuries are described as a sudden ripping or stabbing pain in the groin, and chronic injuries are described as a diffuse dull ache.

Exercise-induced medial thigh pain over the area of the adductors, especially after kicking and twisting, may indicate obturator neuropathy. Pain at the symphysis pubis or scrotum may be more consistent with osteitis pubis. Conjoined tendon lesions present as pain that radiates upward into the rectus abdominis or laterally along the inguinal ligament; exquisite tenderness is present at the site of the injury.

True loss of function is not observed unless a grade 3 tear is present. In the case of a severe tear, loss of hip adduction occurs. Loss of function also should alert the physician to possible nerve involvement (obturator nerve entrapment).

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Physical Examination

The acute adductor strain commonly occurs at the musculotendinous junction. Tenderness, swelling, and ecchymosis can be observed at the superior medial thigh. Sometimes, a defect in the muscle can be palpated. Pain is noted with resisted adduction and full passive abduction of the hip.

A pure hip adductor strain can be distinguished from combination injuries involving the hip flexors (ie, iliopsoas, rectus femoris) by having the patient lie in the supine position. If more discomfort is reproduced with resistive adduction when the knee and hip are extended than if the hip and knee are flexed, a pure hip adductor strain can be assumed.

Physical findings can help distinguish adductor strains from other causes of groin pain, such as the following:

  • Iliopsoas strain: hip flexion against resistance is painful; tenderness is difficult to localize because the insertion of the iliopsoas is deep
  • Osteitis pubis: tenderness of the symphysis pubis and possible loss of full rotation of one or both hip joints are noted
  • Conjoined tendon lesions (ie, sportsman's hernia): exquisite tenderness upon palpation at the inguinal canal; having the patient cough reproduces pain
  • Obturator neuropathy: adductor muscle weakness, muscle spasm, and paresthesia over the medial aspect of the distal thigh may be present; loss of adductor tendon reflex with preservation of other muscle stretch reflexes often is observed; a positive Howship-Romberg sign (medial knee pain induced by forced hip abduction, extension, and internal rotation) sometimes is observed

If a mass is felt in the middle to upper thigh, the physician must consider a rupture at the distal musculotendinous junction. Tumor and hernia also should be ruled out. These conditions warrant a surgical consultation.

Obturator nerve entrapment should be suspected if there is exercise-induced medial thigh pain that starts at the origin of the adductor longus and radiates distally along the medial thigh. Denervation of the adductor muscles is seen on needle electromyography (EMG). The treatment for obturator nerve entrapment is nonoperative, with surgical neurolysis in recalcitrant cases.

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Contributor Information and Disclosures
Author

Marlon P Rimando, MD Assistant Clinical Professor, Department of Medicine, University of Hawaii, John A Burns School of Medicine

Marlon P Rimando, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, National Strength and Conditioning Association

Disclosure: Nothing to disclose.

Coauthor(s)

Bruce B Fry, DO Director, Division of Physical Medicine and Rehabilitation, Knoxville Orthopedic Clinic, St Mary's Hospital

Bruce B Fry, DO is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, North American Spine Society, American Society of Interventional Pain Physicians, International Spine Intervention Society

Disclosure: Nothing to disclose.

Robert Brunner, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine

Robert Brunner, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Medical Association, Southern Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Acknowledgements

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Martin K Childers, DO, PhD Associate Professor, Department of Neurology, Wake Forest University Health Services

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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Lateral lunge.
Lateral lunges.
Lateral lunges.
Lateral lunges.
Lateral lunges.
X lunges. Starting position.
X lunges.
X lunges. Back to the starting position.
X lunges.
Hip flexor stretch.
Hip flexor stretch, isolation of the rectus femoris.
Elastic bandage applied to give pain relief from an adductor strain.
 
 
 
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