Adductor Tendinitis

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Also Known As

Adductor Strain, Groin Strain, Adductor Tenoperiostitis (junction between the tendon and the lining of the bone)

Mechanism of Injury

This is an overload injury caused by excessive stretching or violent contraction of the Adductor muscles. In adolescence, it is possible to avulse (pull part of the bone away) the growth plate. In adults it is usually confined to the tendon tissue or tenoperiosteal junction (junction between the tendon and the lining of the bone)

Sports

Can occur in most sports but especially those that require sudden rotation and or acceleration i.e. Football, Rugby, Hockey and Martial Arts etc

Incidence

• All ages
• More common in males

Pathology

• The injury may occur as a result of a sudden violent overload e.g. kicking a ball at the same time as opposition player kicking ball
• In less violent overloading – repetitive movements cause micro-tearing of the tendon tissue and that leads to a chronic inflammatory pattern similar to ‘tennis elbow’

Symptoms

Acute:

• Sudden severe pain occurs which is aggravated by any contraction of the adductor muscles i.e. squeezing legs together

Chronic:

• Pain usually occurs during activity but may disappear after ‘warming up’
• Pain often continues a few hours after exercise activity
• In severe cases persistent all the time
• Tenderness at the site of the bony attachment in the groin

Signs

• Stress testing – resisted adduction and extension increases
• Stretching the adductors in both flexion and extension of the hips also increases the pain

Differential Diagnosis

• Osteitis Pubis – pain may be on both sides of the midline and pain is often increased by loading the rectus abdominis muscle
• Iliopsoas Strain
• Gilmore’s Groin

Investigations

The following investigations will be useful to determine the diagnosis:

• MRI
• CT Scans (to check for avulsion fractures)
• X-ray (to check for avulsion fractures)
• Ultrasound to look at the tendons in real time

Prevention

• Stretching and Strengthening exercises to the adductor muscles, good core stability, good mobility through the lumbar spine

Treatment

Conservative

• Rest from aggravating activity – total or relative
• Ice
• NSAIDS (Non Steroidal Anti-inflammatory Drugs – Ibuprofen up to Voltarol)
• Stretching to adductors, quadriceps, hip flexors, hamstrings, calf muscles
• Hold/Relax Stretching
• Deep Frictions
• Ultrasound
• Adductor stretching and strengthening exercises (without pain)
• Core stability exercises
• Steroid injections around the Adductor Tendon

Surgery

Is only really contemplated if conservative treatment fails. The surgical options include debridement of the scar tissue and splitting of the adductor tendon up to the pubic bone in order to reduce the stresses through the tendon.