(510) 793-2404
Your Guide to Understanding Sports Hernias and the
 Medical Treatment of
 Sports Hernias
by William Brown, MD
Advanced Medical Treatment for Sports Related Hernias

Adductor Dysfunction

Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections.

Authors: Schilders E1, Bismil Q, Robinson P, O’Connor PJ, Gibbon WW, Talbot JC.

BACKGROUND:
Adductor dysfunction is a condition that can cause groin pain in competitive athletes, but the source of the pain has not been established and no specific interventions have been evaluated. We previously defined a magnetic resonance imaging protocol to visualize adductor enthesopathy. The aim of this study was to elucidate, in the context of adductor-related groin pain in the competitive athlete, the role of the adductor enthesis (origin), the relevance of adductor enthesopathy diagnosed with magnetic resonance imaging, and the efficacy of entheseal pubic cleft injections of local anesthetic and steroids.

METHODS:
We reviewed the findings in a consecutive series of twenty-four competitive athletes who had presented to our sports medicine clinic with groin pain secondary to adductor longus dysfunction. Magnetic resonance imaging was performed to assess the adductor longus origin for the presence or absence of enthesopathy. Seven patients (Group 1) had no evidence of enthesopathy on magnetic resonance imaging, and seventeen patients (Group 2) had enthesopathy confirmed on magnetic resonance imaging. All patients were treated with a single pubic cleft injection of local anesthetic and steroid into the adductor enthesis. At one year after this treatment, the patients were assessed for recurrence of symptoms.

RESULTS:
On clinical reassessment five minutes after the injection, all twenty-four athletes reported resolution of the groin pain. At one year, none of the seven patients in Group 1 had experienced a recurrence. Sixteen of the seventeen patients in Group 2 had a recurrence of the symptoms (p < 0.001) at a mean of five weeks (range, one to sixteen weeks) after the injection.

CONCLUSIONS:
A single entheseal pubic cleft injection can be expected to afford at least one year of relief of adductor-related groin pain in a competitive athlete with normal findings on a magnetic resonance imaging scan; however, it should be employed only as a diagnostic test or short-term treatment for a competitive athlete with evidence of enthesopathy on magnetic resonance imaging.

William Brown, MD
Sports Hernia Specialist

Dr. Brown has been performing sports hernia surgeries and providing specialized rehabilitation programs since 1999.

His clients include the San Jose Sharks, San Jose Sabercats and the San Jose Earthquakes sports teams as well as athletes from the NFL, AFL, NBA, NBL and the United States Soccer League. Athletes from all over the United States as well as from 15 foreign countries have sought out Dr. Brown's expertise.

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