Adductor Thigh Strain

Ovid: 5-Minute Sports Medicine Consult, The

Adductor Thigh Strain
K. Michele Kirk
Brian Lindenmayer
Sebastian Ksionski
  • Medial thigh/adductor pain and weakness resulting from injury to muscle
  • Usually adductor longus muscle, but may include gracilis, iliopsoas, rectus femoris, or sartorius
  • Synonym(s): Groin strain; Pulled groin
Most common cause of groin pain in athletes, but symptoms overlap with a wide differential.
Risk Factors
  • Eccentric loading of muscle (muscle is passively being stretched while it is contracting) is usual mechanism of injury.
  • Inactive or fatigued muscles have less ability to absorb energy and are more likely to undergo acute strain.
  • Acutely, often a stretch injury with an abrupt cutting motion as in slide tackling in soccer (1), or straddling injury as in gymnastics, cheerleading, or horseback riding
  • Also can result from overuse, as in skating or rollerblading
  • May have only minor discomfort with walking, but pain and weakness develop with cutting or running
  • If symptoms do not respond to initial therapy, need to consider other diagnoses.
Physical Exam
  • Classic triad of tenderness to palpation in the muscle and its insertion, pain with passive stretching, and pain with resisted contraction
  • Usually acute episode is noted, but symptoms may become chronic after initial injury if undertreated and repeatedly strained.
  • Tenderness along proximal 1/3 of medial thigh and tendinous origin in pubic region
  • Pain with passive abduction
  • Pain with resisted adduction
  • Swelling and ecchymosis increase suspicion for tear
  • With complete rupture, palpable depression and knot of torn muscle may be present.
Diagnostic Tests & Interpretation
  • Generally not necessary in straightforward cases, but may be part of workup if appropriate
  • Hip and pelvis films recommended to rule out other conditions (1,2)
  • Musculoskeletal US to evaluate for tendon fiber discontinuity or hematoma if there is a palpable mass (1,2)
  • Bone scan if stress fracture suspected
Differential Diagnosis
  • Osteitis pubis
  • Stress fracture of femoral neck or pubic ramus
  • Iliopsoas bursitis
  • Avascular necrosis of femoral head
  • Groin disruption (aka, sports hernia, Gilmore's groin, athletic pubalgia)
  • Myositis ossificans
  • Adductor tendinitis
  • Avulsion fracture (especially in an adolescent)
  • Slipped capital femoral epiphysis (usually seen in early teens)
  • Inguinal hernia
  • Lymphadenopathy
  • Nerve entrapment, specifically obturator nerve (2)
  • Referred pain from spine or genitourinary tract
  • Conjoined tendon lesions (2)
Ongoing Care
Follow-Up Recommendations
Except for significant tears, referral to a specialist generally is not necessary unless another diagnosis is being considered and requires evaluation.
1. Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. 1998;17:787–793, vii.
2. Lacroix VJ. A complete approach to groin pain. Physician Sports Med. 2000;28(1):online.
3. Ruane JJ, Rossi TA. When groin pain is more than “just a strain.” Physician Sports Med. 1998;26(4):online.
4. Anderson M, Hall S, Martin M. Foundations of Athletic Training Prevention, Assessment and Management. 2005:475–477.
5. Sim FH, Nicholas JA, Hershman EB. The Lower Extremity and Spine in Sports Medicine. St. Louis: Mosby, 1995.
Additional Reading
Johnson D, Mair S. Adductor strain. Clin Sports Med. 2006:659.
Fry B, Brunner R. Adductor strain. February 21, 2007.
Macleod DA, Gibbon WW. The sportsman's groin. Br J Surg. 1999:86(7):849–850.
Dahan R. Rehabilitation of muscle tendon injuries to the hip, pelvis, and groin. Vol 5. 1997:326–333.
Baha R, Machlum S. Clin Guide Sports Injur. 2004:266–268.
Garrett WE. Muscle strain injuries. Am J Sports Med. 1996;24:S2–S8.
843.8 Sprain of other specified sites of hip and thigh

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