Summary
An adductor strain is a common injury to the adductor muscle group that occurs as a result of forceful hip extension & external rotation of an abducted leg.
Diagnosis is made clinically with groin pain with tenderness over the inferior pubic rami and decreased strength with resisted leg adduction compared to the other leg.
Treatment is nonoperative with rest, NSAIDs, and protected weight bearing.
Pathophysiology

• Mechanism
  • a “pulled groin,” is caused by forceful hip extension external rotation of an abducted leg.
  • Occurs due to strong eccentric contraction of adductors during play
• Adductor strain classification
  • 1st degree — Pain with minimal loss of strength and motion
  • 2nd degree — Compromised strength
  • 3rd degree — Complete disruption with loss of muscle function

• Anatomy
  • Hip joint adductor complex
    • adductor longus (most common muscle injured in complex)
    • adductor magnus
    • adductor brevis
  • obturator externus
  • pectineus

 Symptoms

• pain is immediate and severe in the groin region
• tenderness is at the site of injury along the subcutaneous border of the pubic ramus.
• pain and/or decreased strength with resisted leg adduction compared to the other leg

An X-ray can be done to check for injury is due to an avulsion then a fleck of bone may be visible and MRI may show avulsion injury of the adductor muscle from the pubic ramus with muscle edema and hemorrhage.
Treatment

• Nonoperative
  • rest, ice, protected weight bearing as needed
  • dictated by the severity of the symptoms but generally consists of a period of rest follow with a rehabilitation program that begins with gentle stretching and progresses to resistance exercise and core strengthening with a gradual return to sports.
  • immobilization should be avoided because this promotes muscle tightness and scarring

• Surgical Treatment
  • Surgery is recommended when conservative approaches do not have an effect in resolving the Adductor strain (which is rare).