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Figure. Coronal magnetic resonance imaging of the pelvis.
A 21-year-old hockey player presents with a complaint of left groin pain that has been present for 6 months. He has been able to play through the groin discomfort until recently when he aggravated the injury during a game. The patient was hit from behind, his leg did a split, and he felt a “pop” in his left groin. He has been unable to push off with skating since the injury. Walking produces only mild pain but running and skating cause the pain to significantly increase. Coronal magnetic resonance imaging (MRI) of the pelvis (Figure) taken 1 week prior to the office visit shows tears of the left pectineus, adductor longus, and adductor brevis off the pubic symphysis with moderate fluid around the tears.
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The hip and groin region is a problematic area for injury in high-level hockey players. The adductor muscles — adductor longus, adductor magnus, and adductor brevis, gracilis, obturator externus, and pectineus — are particularly susceptible to injury when skating at high speeds. Adductor strains/tears occur during eccentric contraction (forces applied to the muscle in a lengthened position). Injury usually occurs at the myotendinous junction of the adductors at the ischium.1,2
Physical examination features of an adductor injury include groin pain with resisted hip adduction and passive stretching of the adductors. Treatment of adductor injuries typically is nonoperative with a period of rest and physical therapy. As the adductor strain heals physical therapy is important to maintain flexibility and hip motion. Adductor strains have a high incidence of reoccurrence, which emphasizes the importance of continued rehabilitation with return to play. Athletes with weak adductors (abductor strength > adductor strength) are more prone to adductor injuries.2
Steroid and PRP injections may be used in patients with chronic adductor pain without structural damage on MRI. Selective adductor surgical release has also been used as a successful treatment in patients with chronic symptoms.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
References
1. Lynch TS, Bedi A, Larson CM. Athletic hip injuries. J Am Acad Orthop Surg. 2017;25(4):269-279. doi:10.5435/JAAOS-D-16-00171
2. Tyler TF, Nicholas SJ, Campbell RJ, McHugh MP. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001;29(2):124-128. doi:10.1177/03635465010290020301.
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