The adductor muscles are located on the medial aspect of the thigh. These muscles adduct the hip joint. Of the adductor muscles, the adductor longus is the most commonly injured. This is because of its limited attachments at the pubic bone and poor mechanical advantage. An injury results in pain high on the inside of the thigh with sports (especially soccer and hockey). The pain can be reproduced by active contraction and palpation of the adductor longus tendon at it origin. Prevention, involves pre-season training to improve the strength of the adductors relative to the abductors and improved flexibility. Once injured, the tendon is very slow to heal because of a poor blood supply at its origin.
Conservative treatment consists of analgesics to control discomfort with active physical therapy. If conservative treatment fails then steroid injections can be helpful. An operation is sometimes required, if other treatments have failed. Surgery…
View the image below to see why I do not use mesh unless necessary.
This athelete’s vas deferens was scarred to the mesh. It was difficult to remove the mesh without damage to the testicle.
The second image shows the mesh after it has been removed. The mesh is stiff and fibrotic.
Athletes often present with a long history of pain and multiple previous operations. This makes determining the exact source of the pain difficult. I often use trigger point injections to try to localize the pain. For example, assume an athlete presents with pain that is near the origin of the adductor longus tendon. If that tendon is injected with lidocaine (a local anesthetic) and the pain gets better, then that would be strong evidence that the adductor longus is the source of the pain. In a similar manner other structures can be injected such as the ilio inguinal nerve, the genital nerve, the spermatic cord, the symphysis pubis, etc With sequential trigger point injection, the etiology of chronic pain can often be identified then the appropriate treatment can be started.
To make the diagnosis of a sports hernia I rely mainly on the history that the patient gives to me and a careful physical examination. Occasionally I order an MRI to help with the diagnosis. In Europe and Australia, ultrasound is used extensively to help make the diagnosis of a sports hernia, but I truly believe that a careful physical exam is the best diagnostic test.