Isolated Acute Hip Adductor Brevis Strain

Discussion

This case conforms to current scientific and clinical data^{[2,3,4,5,6,7,8]} describing acute muscle injuries in that a hip adductor strain occurred as a result of a forceful eccentric contraction, was well-defined by MRI, involved primarily the distal musculotendinous junction, and involved a single muscle within a synergistic group. However, this case appears to be unique in that the injury was an isolated adductor brevis tear; previous reports^[3,8] suggested that the adductor longus was the only muscle of the hip adductor group in which objective sports-related trauma occurred.

As with almost all acute muscle strains, the mechanism of injury in this patient's case involved a powerful eccentric contraction (described by the patient) that exceeded the ultimate biomechanical strength of a single muscle-tendon unit within the synergistic group of hip adductors. Exactly why the adductor brevis was injured in this case, as opposed to the more commonly damaged adductor longus, is not obvious and is not clearly explained by the basic science literature.^[2,4,5,9] The studies^[10,11] describing the biomechanics and kinesiology of ice skating are also limited and provide no further insight into this particular example. The defined predisposing factors for muscle strains include fatigue, muscle architecture, and previous strain injury.^[5,9,12] In this case, fatigue appears to have been the primary contributing variable.

The treatment of this injury was conservative and followed previously described standards.^[1,4] All available methods were used in the acute phase to reduce inflammation and prevent further injury. After the inflammatory phase, progressive (isometric, concentric, then eccentric), specific strengthening of the hip adductor muscle group was combined with ongoing passive stretching to complete the rehabilitation program. The patient was allowed to return to practice sessions and competition only when normal, painless hip adductor function had been achieved.

The modern methods for prevention of this debilitating injury include an aggressive program of hip adductor-specific stretching and strengthening (progressing from isometric to concentric to eccentric exercises) during the off-season and in-season. Furthermore, coaches and athletes alike should be educated regarding the role of previous muscle strain and/or fatigue in producing increased risk for significant muscle injury.

I thank Mehul Desai, MD, Department of Radiology, Cleveland Clinic Florida, Fort Lauderdale, for providing expertise in magnetic resonance imaging for this report.

J South Orthop Assoc. 2000;9(3) © 2000 Southern Medical Association

Cite this: Isolated Acute Hip Adductor Brevis Strain - Medscape - Sep 01, 2000.