Adductor Muscles
More information about this on the upper leg muscles cheat sheet
Sudden change of direction - rapid adduction of the hip against abduction force - stresses tendon
Sudden acceleration (sprinting) - most common
Most injured at the musculotendinous junction - area of poor blood supply and rich nerve supply
Adductor muscles
Contain: adductor Longus, adductor brevis, adductor Magnus, gracilis, pectineus, obturator externus |
Innervated by obturator nerve apart from the pectineus (femoral) |
Magnus/longus is the most strained due to mechanical disadvantage - not made for explosive movements & longus has low tendon to muscle ratio |
Types
Acute: involves musculotendinous junction/muscle belly |
Chronic: proximal irritation at the tendinous junction |
Grade 1: Pain with minimal loss of mobility or strength |
Grade 2: Partial loss of strength and function |
Grade 3: complete muscle/tendon disruption with loss of function |
Demographic
People who play sport which involves forceful eccentric contraction of the adductors (especially in external rotation and abduction of the leg) |
- Kicking, sprinting, forceful trunk rotation, side to side cutting , sudden changes in direction |
- Ice hockey , soccer , football, rugby running, tennis, basketball, powerlifters (sumo stance) |
- Usually occurs again after previous adductor injury |
- inadequate physical conditioning (decreased ROM, previous hip/groin injury, inadequate stretching/strengthening of adductors) |
- Athletes with thigh adductor : abductor strength ratio of <4:5 |
- Age |
- Excessive pronation or leg-length discrepancy |
Presentation
- Sudden onset of pain on proximal inner thigh , can radiate distally |
- Pain provoked by movement , muscle stretch and eccentric contraction |
- Bruising/swelling in moderate-severe injuries |
- Tenderness over inguinal ring and proximal inner thigh |
- Pain on passive abduction or resisted adduction |
- +ve thigh adductor squeeze test (adductor Magnus and gracilis) |
- Neurological testing unremarkable, but sometimes adductor weakness and or sensory loss over medial thigh can occur (obturator neuropathy) |
- Assessment of lumbar spine, SI and hip (biomechanical) |
- Assess for hyperpronation, lower crossed , glut med weakness |
Imaging
- MRI showing oedema of adductors on the right
- Plain film radiographs can help rule out tendon avulsion or bony pathology (AP and frog-leg of the hip)
- Ultrasound can be considered if no bony pathology is suspected
Ddx
- Osteistis pubis (tenderness over pubis symphysis) |
- Athletic pubalgia (sports hernia, abdominal pressurisation tests +ve) |
- inguinal hernia |
- hip pathology ( FAI, avascular necrosis, SCFE, LCP, transient synovitis , degeneration, f# |
- GI/GU pathology |
- Referred lumbrosacral pain |
- Neuropathy of obturator, iliohypogastric,ilioinguinal nerve |
- Iliopsoas bursitis/tendinitis |
- Rec fem tendinitis |
Management
- RICE for 48 hours |
- TENS , US, STW |
- Rehab phase 1: hip ROM and stretching of uninvolved muscles, isometric adduction, non weight bearing progressive resistance for hip flexion, extension and abduction, strengthening of trunk, upper body and contralateral lower extremity |
- Balance board exercises |
- Patient can carry onto phase 2 when patient can perform pain free concentric adduction |
- Phase 2: ball squeezes, sumo squats, single leg stance, standing adduction with resistance band and seated, lunges, lateral squats and lat lunges, sliding board, patient advised to swim or cycle |
- When patients can passively move and the affected side and strength equal to than the unaffected, phase 3 can begin |
- Phase 3: more load, intensity and speed, sport specific drills |
- Athletes are allowed to return to sports when they regain full pain free ROM and 75% full strength |
- Should be better within 4 weeks if acute. If moderate-acute , 4-8 weeks recovery, chronic up to 6 months |
- Reassure patient that discomfort when returning is not uncommon |
- Consider LP SMT, STW, myofascial release |
- Address biomechanical dysfunction |
- Patient advised to wear proper footwear and not run on hard/soft surfaces |
- Adductor strengthening can prevent strains |
- Consider surgical referral if strain is no better with conservative care, full thickness tears/avulsion injuries with persistent weakness of the affected limb
Prognosis
- Favourable |
- Minimal pain and normal function if fully rested and rehabed |
- >20 weeks after injury recovery for athletes |
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