Clinical Examination: Acute Adductor Injuries
Clinical Examination: Acute Adductor Injuries
Clinical Examination: Acute Adductor Injuries
ADDUCTOR INJURIES
Clinical
Examination
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Figures reproduced with permission from BMJ Publishing Group Limited [Can standardised clinical examination of athletes with acute groin
injuries predict the presence and location of MRI findings? Serner et al, Br J Sports Med, Vol. 50(24), 1541-1547 - Appendix 1, Dec 2016].
PAIN PROVOCATION TESTS
ADDUCTOR PALPATION
Adductor palpation
The patient lies supine with the tested leg placed in a relaxed position
with the knee on the examiner’s thigh. The hip of the tested leg is
flexed, slightly abducted and externally rotated. If palpation pain is
present, the distance from the pubic insertion is recorded, as well as
the length and width of pain.
Adductor Longus
The examiner palpates the adductor longus insertion on the pubic
bone just inferior to the pubic tubercle and follows the adductor
longus tendon and muscle distally.
Gracilis
The examiner palpates the gracilis muscle a few cm. distal to the
pubic insertion to distinguish the gracilis from the adductor longus.
The gracilis is then palpated both proximally to the insertion and
distally along the muscle.
Pectineus
The examiner palpates the pubic tubercle and follows the superior
pubic ramus a few cm. laterally. Palpation is then performed a few
cm. distal from this point within the femoral triangle, lateral to the
adductor longus, and medial to the femoral vein, artery and nerve.
While the examiner palpates the pectineus with a firm pressure with
one hand, the patient is asked to push against the examiner’s arm
which is placed medially on the knee of the tested leg. The examiner
should then be able to feel the pectineus contracting.
4 I Assessment of acute adductor injuries
Gracilis palpation
Pectineus palpation
PAIN PROVOCATION TESTS
RESISTANCE TESTS
Squeeze 45°
The patient lies supine. One leg is flexed until the medial malleolus is
positioned at the level of the contralateral medial knee joint line. The
other leg is then flexed similarly, so both medial malleoli are next to
each other and the feet flat on the bed. The hips will then be
approximately 45 degrees flexed and the knees approximately 90
degrees flexed. The examiner then positions a clenched fist between
the patient’s knees, and the patient is asked to squeeze the knees
together with maximal force.
Squeeze 0°
The patient lies supine with hips and knees in a neutral position. The
examiner stands at the end of the examination bed with the lower
arm between the patient’s ankles to hold them apart. The patient’s
feet point straight up, and the patient squeezes the ankles together
with maximal force without lifting the legs or pelvis.
Outer-range adduction
The patient lies supine. The examiner moves the leg to the side into
maximal abduction, holding it with one hand to ensure the toes point
straight up. With the other hand, the contralateral leg is supported to
stabilize the testing position. In this position the patient is asked to
push the leg in towards the examiners body.
6 I Assessment of acute adductor injuries
Knees
Mid - Shins
Ankles
Squeeze 45°
Floor
Stretching
Pain
Squeeze 0°
Outer-range adduction
PAIN PROVOCATION TESTS
STRETCH TESTS
8 I Assessment of acute adductor injuries
FABER test
RANGE OF MOTION TESTS
Hip adductor muscles
General
The weight (kg) and lever arm (cm) of the patient is measured.
The lever arm is measured from the anterior superior iliac spine to 8 cm.
proximally from the most prominent point of lateral malleolus, which is
marked together with an equivalent point medially on the tibia.
A practice test should be performed for each strength test followed by 3
maximal contractions with a rest of 30s between each repetition. The
participant exerts a 3s maximum voluntary isometric contraction against
a hand-held dynamometer (HHD) and a break is then performed by the
examiner pushing the leg slowly (2s). The standardized instruction for
the tests is: “go ahead-push-push-push-push-push” lasting total of 5s.
Patients are instructed to push as hard as possible within their comfort
zone. If participants cannot perform the test due to pain – 0 N is noted.
The highest score is recorded.
12 I Assessment of acute adductor injuries
The participants are supine and stabilize themselves by holding onto the
sides of the examination bed with their hands and with an added
stabilization belt around the pelvis. The non-tested leg is flexed at the
knee and hip, placing the sole of the foot flat against the examination
bed with the medial malleolus in line with the contralateral knee joint
line and with the toes resting at the end of the bed. The tested leg is
kept straight at the knee and hip and moved into maximal hip abduction.
When maximal hip abduction is reached the tested leg is taken off full
stretch towards the midline in order to allow an eccentric break during
testing (app. 20 cm). The dynamometer is then placed on the medial
tibia mark and the examiner places own elbow on their own ASIS to
stabilize their arm while testing and a break is performed by the
examiner who pushes own pelvis pushing the leg into further hip
abduction.
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