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A groin strain or a groin pull is an injury to any one of the adductor muscles resulting in inner thigh pain. A pulled groin muscle can range from very mild to completely debilitating. Symptoms of an acute groin strain typically include a sudden sharp pain in the groin area, either in the belly of the muscle or more proximal. There may also be rapid swelling followed by visible bruising. Groin strains are graded 1, 2 or 3 depending on the extent of the injury.
- Grade 1: a small number of muscle fibres are torn resulting in some pain but allowing full function.
- Grade 2: a significant number of muscle fibres are torn with moderate loss of function.
- Grade 3: all muscle fibres are ruptured resulting in major loss of function.
Acute complete ruptures of the proximal adductor longus tendon are rare but challenging injuries to treat. The main function of the adductors is to pull the legs back towards the midline (adduction). In day to day activity, the adductors are used to stabilize and control the movement of the legs when walking or running. In the athlete population these muscles are activated in sports that require running/sprinting, skating, kicking, hurdling and any rapid changes in direction. The rupture or tear in the muscle usually occurs during explosive movements when the leg is in a position against resistance such as kicking a ball.
Diagnosis is often based on physical exam and ultrasound or MRI imaging. It is often alarming when we see the term “full thickness tear” in an imaging report and frequently results in an urgent referral to an orthopaedic surgeon.
This article was interesting and helpful in assisting with the nonoperative management of adductor/groin ruptures and reassuring to know that surgical intervention is rarely necessary. In summary, nonoperative treatment of proximal adductor tendon rupture results in a statistically significantly faster return to play than does operative treatment in athletes competing in the National Football League and avoids the risks associated with surgery while providing an equal likelihood of return to play at the professional level. When extrapolating to the normal population it can be said that return to recreational sport and manual labour jobs can occur successfully with conservative management and physiotherapy.