184: HIP ADDUCTOR STRAIN

Eric Shamus, PhD, DPT, PT, CSCS; Patricia M. Tripp, PhD, ATC

CONDITION/DISORDER SYNONYM

Groin (adductor) strain

ICD-9-CM CODES

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

ICD-10-CM CODES

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

PREFERRED PRACTICE PATTERN

4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation¹

PATIENT PRESENTATION

A 65-year-old physically active and otherwise healthy female (5’7 in, 160 lb) slipped on ice while exiting the passenger side of a car. She described the scenario such that as she attempted to leave the vehicle and stood on her right leg, her foot slipped out beneath her. Although she grabbed onto the door for support and did not fall, she reported feeling a “pulling” sensation and immediate pain over her right inner thigh. She reported to the clinic for assessment—4 days postinjury. She states her inner thigh became “bruised” (black-and-blue) over the past 2 days and the pain has caused difficulty sleeping and performing activities of daily living. As she entered the clinic, she had a slight limp, with shortened stance time noted during right limb ambulation. Her chief complaint is pain. She presented with palpable pain and muscular defect over the mid-muscle belly of her adductor magnus. Active range of motion for hip flexion and extension is within normal limits (WNL), but she reports pain with hip adduction, abduction, and internal/external rotation. Passive ROM elicits pain during hip abduction and external rotation. She has 5/5 strength with hip flexion, extension, external rotation, and abduction; and 4/5 with hip adduction and internal rotation.

KEY FEATURES

Description

Partial or complete tearing of the adductor muscles
- Pectineus
- Adductor brevis
- Adductor longus
- Adductor magnus
- Gracilis
May report feeling a pop/pulling sensation 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

FIGURE 184-1

Adductor muscle strain/rupture is heralded in this patient by the degree of ecchymosis present. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. http://www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)