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Adductor muscle and tendon injury

Jon Patricios, MBBCh, MMedSci, FACSM, FFSEM (UK)
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Groin injuries are common in sport, particularly those involving rapid acceleration, deceleration, and change of direction. Often these injuries involve acute strains (minor tears) of the adductor muscles or chronic damage to the adductor tendons.

The clinical presentation, evaluation, and management of acute and chronic adductor muscle and tendon injuries are reviewed here. Other musculoskeletal injuries of lower extremity are discussed separately. (See "Hamstring muscle and tendon injuries" and "Quadriceps muscle and tendon injuries".)


The adductors of the hip are part of the inner hip and thigh musculature and range from the lower pelvic bone to the femur and knee region (figure 1 and figure 2). They lie between the quadriceps muscles anteriorly and the hamstring muscles posteriorly. The adductors are innervated by the obturator nerve (figure 3), with the exception of the pectineus, which receives innervation from the femoral nerve. The hip adductors determine the shape of the medial thigh and include the following muscles:

Adductor magnus muscle (figure 4) – One of the biggest muscles of the human body, the adductor magnus originates at the inferior pubic ramus, the ischial ramus, and the ischial tuberosity, and inserts both at the linea aspera ("muscular, fleshy insertion") and the medial femoral epicondyle ("tendinous insertion"). The superficial part of the adductor magnus is supplied by the tibial nerve.

Adductor longus muscle (figure 5) – The adductor longus originates at the superior pubic ramus and the pubic symphysis and inserts at the linea aspera. Distally it forms an aponeurosis (vasto-adductor membrane) that extends to the vastus medialis muscle.

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Literature review current through: Dec 2017. | This topic last updated: May 03, 2017.
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  1. Tubbs RS, Griessenauer CJ, Marshall T, et al. The adductor minimus muscle revisited. Surg Radiol Anat 2011; 33:429.
  2. Kai B, Lee KD, Andrews G, et al. Puck to pubalgia: imaging of groin pain in professional hockey players. Can Assoc Radiol J 2010; 61:74.
  3. Lynch SA, Renström PA. Groin injuries in sport: treatment strategies. Sports Med 1999; 28:137.
  4. Tyler TF, Silvers HJ, Gerhardt MB, Nicholas SJ. Groin injuries in sports medicine. Sports Health 2010; 2:231.
  5. Robinson P, White LM. The biomechanics and imaging of soccer injuries. Semin Musculoskelet Radiol 2005; 9:397.
  6. Holmich P, Bradshaw C. Groin Pain. In: Clinical Sports Medicine, Brukner P, Khan K (Eds), McGraw-Hill, Australia 2013. p.549.
  7. Geraci MC Jr, Brown W. Evidence-based treatment of hip and pelvic injuries in runners. Phys Med Rehabil Clin N Am 2005; 16:711.
  8. Nicholas SJ, Tyler TF. Adductor muscle strains in sport. Sports Med 2002; 32:339.
  9. Serner A, Tol JL, Jomaah N, et al. Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med 2015; 43:1857.
  10. Orchard JW. Men at higher risk of groin injuries in elite team sports: a systematic review. Br J Sports Med 2015; 49:798.
  11. Hölmich P, Thorborg K, Dehlendorff C, et al. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med 2014; 48:1245.
  12. Werner J, Hägglund M, Waldén M, Ekstrand J. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 2009; 43:1036.
  13. Lorentzon R, Wedrèn H, Pietilä T. Incidence, nature, and causes of ice hockey injuries. A three-year prospective study of a Swedish elite ice hockey team. Am J Sports Med 1988; 16:392.
  14. Rishiraj N, Lloyd-Smith R, Lorenz T, et al. University men's ice hockey: rates and risk of injuries over 6-years. J Sports Med Phys Fitness 2009; 49:159.
  15. Giza E, Mithöfer K, Farrell L, et al. Injuries in women's professional soccer. Br J Sports Med 2005; 39:212.
  16. Ekstrand J, Gillquist J. The avoidability of soccer injuries. Int J Sports Med 1983; 4:124.
  17. 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; 29:124.
  18. Whittaker JL, Small C, Maffey L, Emery CA. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med 2015; 49:803.
  19. Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc 2001; 33:1423.
  20. Seward H, Orchard J, Hazard H, Collinson D. Football injuries in Australia at the élite level. Med J Aust 1993; 159:298.
  21. Pelvic biomechanics www.rice.edu/~jenky/sports/pelvic.biomech.html (Accessed on February 04, 2014).
  22. Hägglund M, Waldén M, Ekstrand J. Risk factors for lower extremity muscle injury in professional soccer: the UEFA Injury Study. Am J Sports Med 2013; 41:327.
  23. Witvrouw E, Danneels L, Asselman P, et al. Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players. A prospective study. Am J Sports Med 2003; 31:41.
  24. Allen DG, Lamb GD, Westerblad H. Skeletal muscle fatigue: cellular mechanisms. Physiol Rev 2008; 88:287.
  25. Crockett L, Ekeland A, Shamoo AE. Sports Medicine for Coaches and Athletes: Skiing, 1st ed, CRC Press, Amsterdam 2000. Vol 4, p.48.
  26. Chang R, Turcotte R, Pearsall D. Hip adductor muscle function in forward skating. Sports Biomech 2009; 8:212.
  27. Lockwood K, Frost G. When metal meets ice: Potential for performance or injury. Abstract and oral presentation, Fifth International Symposium on Safety in Ice Hockey, Denver, Colorado, USA, May 2007.
  28. Hintermeister RA, O'Connor DD, Lange GW, et al. Muscle activity in wedge, parallel, and giant slalom skiing. Med Sci Sports Exerc 1997; 29:548.
  29. Evans NA, Bowrey DJ, Newman GR. Ultrastructural analysis of ruptured tendon from anabolic steroid users. Injury 1998; 29:769.
  30. Banks DB, MacLennan I, Banks AJ. Adductor longus ruptures in elite sportsmen--pitfalls of surgical repair: a report of two cases. BMJ Case Rep 2013; 2013.
  31. Branci S, Thorborg K, Nielsen MB, Hölmich P. Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature. Br J Sports Med 2013; 47:611.
  32. Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol 2008; 191:962.
  33. Knockaert DC, D'Heygere FG, Bobbaers HJ. Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain. Postgrad Med J 1989; 65:632.
  34. ter Meulen BC, Peters EW, Wijsmuller A, et al. Acute scrotal pain from idiopathic ilioinguinal neuropathy: diagnosis and treatment with EMG-guided nerve block. Clin Neurol Neurosurg 2007; 109:535.
  35. Girish G, Finlay K, Fessell D, et al. Imaging review of skeletal tumors of the pelvis malignant tumors and tumor mimics. ScientificWorldJournal 2012; 2012:240281.
  36. Picchio M, Mascetti C, Tanga I, Spaziani E. Metastasis from renal cell carcinoma presenting as skeletal muscle mass: a case report. Acta Chir Belg 2010; 110:399.
  37. Schlegel TF, Bushnell BD, Godfrey J, Boublik M. Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes. Am J Sports Med 2009; 37:1394.
  38. Kumar A, Doran J, Batt ME, et al. Results of inguinal canal repair in athletes with sports hernia. J R Coll Surg Edinb 2002; 47:561.
  39. Jensen J, Hölmich P, Bandholm T, et al. Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomised controlled trial. Br J Sports Med 2014; 48:332.
  40. Davis JA, Stringer MD, Woodley SJ. New insights into the proximal tendons of adductor longus, adductor brevis and gracilis. Br J Sports Med 2012; 46:871.
  41. Serner A, Jakobsen MD, Andersen LL, et al. EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. Br J Sports Med 2014; 48:1108.
  42. Karlsson J, Swärd L, Kälebo P, Thomée R. Chronic groin injuries in athletes. Recommendations for treatment and rehabilitation. Sports Med 1994; 17:141.
  43. Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med 2009; 28:113.
  44. Hamid MS, Yusof A, Mohamed Ali MR. Platelet-rich plasma (PRP) for acute muscle injury: a systematic review. PLoS One 2014; 9:e90538.
  45. Hsu WK, Mishra A, Rodeo SR, et al. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg 2013; 21:739.
  46. Andia I, Maffulli N. Platelet-rich plasma for muscle injury and tendinopathy. Sports Med Arthrosc 2013; 21:191.
  47. Bubnov R, Yevseenko V, Semeniv I. Ultrasound guided injections of platelets rich plasma for muscle injury in professional athletes. Comparative study. Med Ultrason 2013; 15:101.
  48. Schilders E, Dimitrakopoulou A, Cooke M, et al. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med 2013; 41:603.
  49. Vogt S, Ansah P, Imhoff AB. Complete osseous avulsion of the adductor longus muscle: acute repair with three fiberwire suture anchors. Arch Orthop Trauma Surg 2007; 127:613.
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