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Condition/Disorder Synonym

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  • Groin (adductor) strain

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ICD-9-CM Codes

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  • 843 Sprains and strains of hip and thigh

  • 843.8 Sprain of other specified sites of hip and thigh

  • 843.9 Sprain of unspecified site of hip and thigh

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ICD-10-CM Codes

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  • S73.109A Unspecified sprain of unspecified hip, initial encounter

  • S73.199A Other sprain of unspecified hip, initial encounter

  • S76.919A Strain of unspecified muscles, fascia and tendons at thigh level, unspecified thigh, initial encounter

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Preferred Practice Pattern

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Key Features

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Description

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  • Tear or rupture of the adductor muscles

    • Pectineus

    • Adductor Brevis

    • Adductor Longus

    • Adductor Magnus

    • Gracilis

  • Athletes often feel a pop in the muscle

  • Condition may result in abnormal stress to the pubic bone, pubic tubercle, or pubic symphysis

  • Pubalgia-osteitis pubis: a collective term referring to disorders that cause chronic pubic pain

  • Symptoms from increased mechanical stress in pubic region due to abnormalities or stress from osseous, ligamentous, or muscular structures

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Essentials of Diagnosis

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  • Diagnosed primarily through signs and symptoms, exclusion of other pathologies typical to the region

  • Ball or roll of fibers on palpation

  • Grade 1: minor stretch or tear of < 10% of fibers

  • Grade 2: 10 to 90% of fibers torn

  • Grade 3: full tear, rupture

  • Can result from chronic, repetitive stress/exertion during sports (kicking, sprinting, or twisting at high speeds)

  • May be acute tear with sudden movement of hip abduction

  • Differential diagnosis for other orthopedic (pubic, spine) or medical (intra-abdominal pathology, hernia) pathologies that warrant more immediate intervention is essential

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General Considerations

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  • Pubalgia-osteitis pubis: a collective term referring to disorders that cause chronic pubic pain

    • Caused by repeated trauma from activities that over-stress the pubic bone or tendons, causing shearing of the pubic symphysis

  • Diagnosis often made through exclusion of other pathologies

  • Full history, medical screening, and differential examination of pelvic/lower abdominal ensure appropriate diagnosis

  • Treatment based on severity, duration of symptoms, associated pathology, physician preference

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Demographics

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  • Common in participants of exertional sports.

  • Often a result of slip and fall

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Clinical Findings

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Signs and Symptoms

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  • Pain from kicking, running, sprinting, squats

  • Tenderness over the muscle belly

  • Possible tenderness over proximal insertions of the adductor tendons or insertion of the rectus abdominus

  • Possible pain and limited ROM with passive hip flexion or abduction

  • Possible weakness of lower abdominals or any components of hip musculature

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Functional Limitations

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  • Pain/limitation with running

  • Pain/limitation between sitting and rising from chair

  • Pain/limitation with getting up from floor

  • Pain/limitation with rising from supine positions

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Possible Contributing Causes

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  • Muscle imbalance

  • Forceful trauma or slipping ...

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