Approach Considerations

Radiographs should be taken with the patient standing on one leg. Radiographs are used to evaluate for osteitis pubis with extrusion of the fibrocartilaginous disk and degeneration of adjacent bony margins.

Ultrasonograms may indicate abnormal findings, such as sonolucent areas and tendon fiber discontinuity that can be indicative of injury to the following 3 sites: (1) the tendon insertion, (2) the tendon itself, and (3) the musculotendinous junction. Ultrasonography can also be used to evaluate a mass. CT scanning and MRI can be used to evaluate for complete and partial adductor muscle tears.^[3]

Technetium-99m (^99mTc) scanning has been shown to assist the physician in the diagnosis of osteitis pubis.^[4]

Urinalysis should be considered only if a genitourinary cause is suggested.

A study by Falvey et al indicated that the adductor squeeze test has 85.4% sensitivity for athletic groin pain from pubic aponeurosis injury or adductor pathology but is not specific for these. The study involved 382 male patients.^[22]

Treatment & Management

Feeley BT, Powell JW, Muller MS, et al. Hip injuries and labral tears in the national football league. Am J Sports Med. 2008 Nov. 36(11):2187-95. [QxMD MEDLINE Link].
Kiel J, Kaiser K. Adductor Strain. StatPearls. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Kalebo P, Karlsson J, Sward L. Ultrasonography of chronic tendon injuries in the groin. Am J Sports Med. 1992 Nov-Dec. 20(6):634-9. [QxMD MEDLINE Link].
Briggs RC, Kolbjornsen PH, Southall RC. Osteitis pubis, Tc-99m MDP, and professional hockey players. Clin Nucl Med. 1992 Nov. 17(11):861-3. [QxMD MEDLINE Link].
Hanna CM, Fulcher ML, Elley CR, et al. Normative values of hip strength in adult male association football players assessed by handheld dynamometry. J Sci Med Sport. 2009 Jun 30. [QxMD MEDLINE Link].
Davis JA, Stringer MD, Woodley SJ. New insights into the proximal tendons of adductor longus, adductor brevis and gracilis. Br J Sports Med. 2011 Oct 17. [QxMD MEDLINE Link].
Hureibi KA, McLatchie GR. Groin pain in athletes. Scott Med J. 2010 May. 55(2):8-11. [QxMD MEDLINE Link].
LeCroy CM, Reedy MK, Seaber AV. Limited sarcomere extensibility and strain injury in rabbit skeletal muscle. Trans Orthop Res Soc. 1989. 14:316.
Estwanik JJ, Sloane B, Rosenberg MA. Groin Strain and other Possible Causes of Groin Pain. Sports Med. 1990. 18:59-65.
Ziprin P, Williams P, Foster ME. External oblique aponeurosis nerve entrapment as a cause of groin pain in the athlete. Br J Surg. 1999 Apr. 86(4):566-8. [QxMD MEDLINE Link].
Rassner L. Lumbar plexus nerve entrapment syndromes as a cause of groin pain in athletes. Curr Sports Med Rep. 2011 Mar-Apr. 10(2):115-20. [QxMD MEDLINE Link].
Ryan J, DeBurca N, Mc Creesh K. Risk factors for groin/hip injuries in field-based sports: a systematic review. Br J Sports Med. 2014 Jul. 48(14):1089-96. [QxMD MEDLINE Link].
Mosler AB, Weir A, Serner A, et al. Musculoskeletal Screening Tests and Bony Hip Morphology Cannot Identify Male Professional Soccer Players at Risk of Groin Injuries: A 2-Year Prospective Cohort Study. Am J Sports Med. 2018 May. 46 (6):1294-1305. [QxMD MEDLINE Link].
Serner A, Tol JL, Jomaah N, et al. Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med. 2015 Aug. 43 (8):1857-64. [QxMD MEDLINE Link].
Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport. 1995. 27:76-79.
Renstrom P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980 Mar. 14(1):30-6. [QxMD MEDLINE Link]. [Full Text].
Eckard TG, Padua DA, Dompier TP, Dalton SL, Thorborg K, Kerr ZY. Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015. Am J Sports Med. 2017 Oct. 45 (12):2713-22. [QxMD MEDLINE Link].
Orchard JW. Men at higher risk of groin injuries in elite team sports: a systematic review. Br J Sports Med. 2015 Jun. 49 (12):798-802. [QxMD MEDLINE Link].
Serner A, Weir A, Tol JL, et al. Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries: A Prospective Cohort Study. Am J Sports Med. 2020 Apr. 48 (5):1151-9. [QxMD MEDLINE Link].
Serner A, Weir A, Tol JL, et al. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthop J Sports Med. 2020 Jan. 8 (1):2325967119897247. [QxMD MEDLINE Link]. [Full Text].
Serner A, Holmich P, Tol JL, et al. Progression of Strength, Flexibility, and Palpation Pain During Rehabilitation of Athletes With Acute Adductor Injuries: A Prospective Cohort Study. J Orthop Sports Phys Ther. 2021 Mar. 51 (3):126-34. [QxMD MEDLINE Link].
Falvey EC, King E, Kinsella S, Franklyn-Miller A. Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients-clinical findings, MRI findings and patient-reported outcome measures at baseline. Br J Sports Med. 2015 Nov 30. [QxMD MEDLINE Link].
Dahan R. Rehabilitation of Muscle-Tendon Injuries to the Hip, Pelvis, and Groin Areas. Vol 5. 1997:326-333.
DePalma B, Prentice WE, eds. Rehabilitation of groin, hip, and thigh injuries. In: Rehabilitation Techniques in Sports Medicine. 3rd ed. 1999:411-443.
Lynch SA, Renstrom PA. Groin injuries in sport: treatment strategies. Sports Med. 1999 Aug. 28(2):137-44. [QxMD MEDLINE Link].
Swain R, Snodgrass S. Managing groin pain: even when the cause is not obvious. Phys Sports Med. 1995. 23(11):55-66.
Weir A, Jansen JA, van de Port IG, Van de Sande HB, Tol JL, Backx FJ. Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Man Ther. 2011 Apr. 16(2):148-54. [QxMD MEDLINE Link].
Weir A, Jansen J, van Keulen J, Mens J, Backx F, Stam H. Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: a case series. Phys Ther Sport. 2010 Aug. 11(3):99-103. [QxMD MEDLINE Link].
Delmore RJ, Laudner KG, Torry MR. Adductor longus activation during common hip exercises. J Sport Rehabil. 2014 May. 23 (2):79-87. [QxMD MEDLINE Link].
Frizziero A, Trainito S, Oliva F, Nicoli Aldini N, Masiero S, Maffulli N. The role of eccentric exercise in sport injuries rehabilitation. Br Med Bull. 2014 Jun. 110 (1):47-75. [QxMD MEDLINE Link].
Renstrom PA. Tendon and muscle injuries in the groin area. Clin Sports Med. 1992 Oct. 11(4):815-31. [QxMD MEDLINE Link].
Schilders E, Talbot JC, Robinson P, et al. Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2009 Oct. 91(10):2455-60. [QxMD MEDLINE Link].
Akermark C. Surgery of the adductor longus. In: Proceedings of the American Academy of Orthopaedic Sports Medicine. Lake Tahoe:. 1982.
Neuhaus P, Gabriel T, Maurer W. [Adductor insertion tendopathy, operative therapy and results]. Helv Chir Acta. 1983 Jan. 49(5):667-70. [QxMD MEDLINE Link].
Randin EL, Simon SR, Rose RM. Practical Biomechanics for the Orthopaedic Surgeon. NY:. John Wiley & Sons Inc. 1979:165.
Martens MA, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy. Am J Sports Med. 1987 Jul-Aug. 15(4):353-6. [QxMD MEDLINE Link].
Schlegel TF, Bushnell BD, Godfrey J, et al. Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes. Am J Sports Med. 2009 Jul. 37(7):1394-9. [QxMD MEDLINE Link].

Media Gallery

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.

of 12

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

Stephen Kishner, MD, MHA Clinical Professor, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

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

Adductor Strain Workup

Approach Considerations

References

Tables

Contributor Information and Disclosures

What would you like to print?