The muscles contain a higher proportion of type 2 muscle fibres than the other muscles of the lower extremity; suggesting high intrinsic force generation. While stress injuries in general are a common occurrence in athletes, adductor insertion avulsion syndrome (AIAS) is Case study. 3 Avulsion fracture sustained by a 45-year-old man. • Hip Flexor and Adductor Injuries ‒Typically Acute Event ‒Gymnastics or Martial Arts on occasion ‒Soccer Athletes ‒Typically treated conservatively ‒Rare need to fix large displaced rectus avulsion Hip Flexors and Adductors • Acute injuries typically resolve with appropriate non-surgical care ‒Rest, Therapy, Rehab, slow RTP program Findings An AP x-ray image conducted at the time of injury shows evidence of a lesser trochanter avulsion fracture. “Thigh splints,” also known as the adductor insertion avulsion syndrome, is a painful condition affecting the proximal to mid femur at the insertion of the adductor muscles of the thigh. Diagnosis is made clinically with groin pain with tenderness over the inferior pubic rami and decreased strength with resisted leg adduction compared to the other leg. The patient may report an acute onset of pain or tearing sensation in the proximal posterior thigh. Surgical anatomy. Presentation of a patient with proximal adductor magnus avulsion mimics that of a patient with a proximal hamstring avulsion. Fig. a. Oblique head – inferior ramus of pubis & ischial ramus. Further imaging obtained following surgical consultation revealed a partial In 25% of complete UCL ruptures, an avulsion fracture is evident at the base of the proximal phalanx of the thumb (25%) . b. Vertical head – adductor tubercle of femur. “Thigh splints,” also known as the adductor insertion avulsion syndrome, is a painful condition affecting the proximal to mid femur at the insertion of the adductor muscles of the thigh. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. Magnetic resonance imaging Introduction Adductor insertion avulsion syndrome, or “thigh splints”, is a painful condition affecting the insertion of the ad-ductor muscles of the thigh from the proximal to the mid-femoral level. The superficial insertion of the adductor mechanism is the extensor expansion via the adductor aponeurosis; the deep insertion extends to the palmar aspect of the proximal phalanx via the ulnar sesamoid of the metacarpophalangeal joint. ( a ) Coronal and ( b ) sagittal short tau inversion recovery MRI show avulsion of the proximal tendon of the left AL with an osseous defect at the left pubic tubercle ( red arrow ). Also found was a par-tial tear of the left adductor brevis and mild strain of the left pectineus (FIGURE 1). An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Less commonly, the athlete who suffers a sudden apophyseal separation or avulsion may present with acute or acute-on-chronic symptoms. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. •Nonoperative treatment for proximal avulsion of the rectus femoris in professional American football. This masterclass will provide you with a complete understanding of the anatomy, pathology and presentation of proximal … The adductor magnus (AM) has historically been a potential source of confusion in patients with suspected proximal hamstring avulsion injuries. 2. We report a case of a 56-year-old healthy man who sustained an acute osseous avulsion of the adductor sleeve complex on the left side, which was surgically repaired with bone anchors and a mesh. Adductor Strain. proximal insertion in 26%, the musculotendinous junction in 37%, and the distal insertion in 37%.6 Of those injuries that occurred at the proximal insertion, 75% were complete avulsion injuries.6 Partial and distal avulsions of the adductor longus have been shown to … Injury to the UCL, most often at its distal portion,4,14,15 may result in a sprain or full-thickness tear of the ligament. a displaced avulsion fracture; the presence of a Stener lesion (interposition of the adductor pollicis muscle and adductor aponeurosis between the torn end of the UCL and the base of the proximal phalanx) 3. proximal adductor longus tendon - avulsion - groin injury - suture anchor repair Literatur 1 Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. The results of the 2 patients who underwent ORIF were excluded from this study.Surgical treatment has been advocated for various indications in avulsion fractures of the UCL of the thumb MCP joint. Patient Evaluation/Preoperative Assessment Presentation of a patient with proximal adductor magnus avulsion mimics that of a patient with a proximal hamstring avulsion. This fragment may be a small fleck or may be of substantial size. The musculoskeletal radiology team initially interpreted the MRI as a soft tissue proximal hamstring avulsion. Deepak Patkar. When this occurs a large amount of bleeding ... (such as a hip adductor … Less commonly, the athlete who suffers a sudden apophyseal separation or avulsion may present with acute or acute-on-chronic symptoms. Purpose: To investigate the anatomic characteristics of the AM, including its osseous origin, anatomic dimensions, and relationship to the proximal hamstring tendons. The adductor longus seems to be the most commonly injured muscle but other adductors such as adductor brevis, pectineus, and gracilis may be injured [56-58]. Right,Division of the adductor aponeurosis is required for repair of the ligament. Proximal avulsion injuries of the adductor longus have been managed both conservatively and operatively with good clinical outcomes. He was unable to weight bear. To our knowledge a complete osseous avulsion of the adductor sleeve has not been described previously. Surgical reattachment utilizing a multiple suture anchor technique is a successful procedure that allows for a safe return to athletic performance and a predictable return to sport. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Proximal rupture of the adductor longus tendon is a rare injury, particularly avulsion injures at the pubic bone. Surgical reattachment utilizing a multiple suture anchor technique is a successful procedure that allows for a safe return to athletic performance at a mean of 4.8 months, with a low risk of complications. If you perform an exercise incorrectly or abruptly, it can cause you to suffer a hip adductor tendinopathy, as indicated in the article Proximal hamstring tendon avulsion: surgical treatment in high-performance athletes. 1. After immobiliza-tion for 4 weeks, the thumb was painless and stable. Occasionally, radiographs will show an avulsion fracture from the ulnar aspect of the base of the proximal phalanx . Chronic vague hip pain may be caused by stress-related injury in the proximal or mid-femoral diaphysis. The lateral instability of the first metatarsophalangeal joint was believed to be due to the disruption of adductor hallucis function. This has been described as an entity called adductor insertion avulsion syndrome, or thigh splints. PELVIC INJURIES. The tendon’s thickness, fibrousness and poor blood supply are the causes of difficult healing.. Indications. Purpose: To investigate the anatomic characteristics of the AM, including its osseous origin, anatomic dimensions, and relationship to the proximal hamstring tendons. Especially in competitive athletes, recent trends have advocated for surgical repair of these acute injuries. The purpose of this study was to investigate the detailed anatomy of the entheses and proximal musculotendinous junctions (MTJs) of adductor longus (AL), adductor brevis (AB) and gracilis. Note the difference in origin of the 2 components of the adductor magnus muscle and the medial location compared with the semimembranosus and conjoint tendons. A3 – Avulsion fracture to include the distal insertion of the ulnar collateral ligament (UCL) involving the base of the medial proximal phalanx. The adductor longus arises from the anterior pubic body below the pubic crest via a consistently seen tendon and a deeper, more variable muscular attachment 7 (4a,5a). It is related to chronic traction stress of the adductor muscles at their insertion site along the posterior margin of the proximal and mid-femoral diaphysis, and it can get complicated by stress fracture. Using our previously described anterior pubic symphyseal portal and an anteromedial adductor portal, initial … Australasian Radiology, 2007. Moderate osteitis pubis with an associated chronic partial avulsion of the left common adductor-rectus proximal and superficial to the proximal edge of the intact adductor aponeurosis. In the thumb however, the avulsed fragment may displace dorsal to the adductor aponeurosis. Purpose: To report on the outcomes of surgical reattachment of proximal adductor avulsion injuries in athletes utilizing a suture anchor repair technique. Am J Sports Med. Further imaging obtained following surgical consultation revealed a partial Significant ecchymosis and a palpable defect may be present at the medial aspect of the ischial tuberosity. is type of injury can take a lengthy time to recover if managed conservatively. than tibial and proximal femoral stress fractures and are thought to be on the continuum of osseous fatigue-/stress-related injuries. If you perform an exercise incorrectly or abruptly, it can cause you to suffer a hip adductor tendinopathy, as indicated in the article Proximal hamstring tendon avulsion: surgical treatment in high-performance athletes. However, traumatic proximal adductor avulsion injuries are relatively rare groin injuries in the athletic population, with limited case reports describing suture anchor repair. • Hip Flexor and Adductor Injuries ‒Typically Acute Event ‒Gymnastics or Martial Arts on occasion ‒Soccer Athletes ‒Typically treated conservatively ‒Rare need to fix large displaced rectus avulsion Hip Flexors and Adductors • Acute injuries typically resolve with appropriate non-surgical care ‒Rest, Therapy, Rehab, slow RTP program However, in some cases, due to overexertion, you might end up suffering from hip adductor tendinopathy. The fibers of the proximal tendon of the adductor longus blend with fibers from the rectus abdominis tendon, a common aponeurosis that covers the anterior aspect of the symphysis pubis and the capsule and disc of the symphysis pubis.The distal attachment of the adductor longus is on the linea aspera of the femur. than tibial and proximal femoral stress fractures and are thought to be on the continuum of osseous fatigue-/stress-related injuries. The adductor insertion avulsion syndrome, also called “thigh splints,” is usually considered a sports injury, causing thigh and groin pain. Proximal adductor avulsion injuries occur in the athletic male population. Serner A, Weir A, Tol JL, et al. An intact adductor magnus may mask a complete avulsion of the hamstring tendons on MRI evaluation as it appears to be an “intact but attenuated semimembranosus tendon.” The authors state an intact adductor magnus may result in a misdiagnosis of patients as having only a partial tear rather than a complete avulsion injury. The return to competition period may take 6-9 months post- surgery and will involve high levels strength work and structured return and return to training programs. Acute avulsion of the rectus abdominis and adductor longus via a traumatic mechanism is rare. Proximal Adductor Avulsions. Schlegel TF, Bushnell Arch Orthop Trauma Surg 2007; 127:613. We demonstrate the feasibility of endoscopic reattachment of an adductor avulsion with >3 cm of retraction. History and etymology Cacchio A, Borra F, Severini G, Foglia A, Musarra F, Taddio N, et al. Acute avulsion of the proximal fibrocartilaginous origin of the adductor longus (AL) is an injury mostly occurring in individuals that perform cutting and rapid lateral movements such as in hockey, soccer, and rugby. In the pelvis, avulsion injuries primarily occur at six sites (, Fig 1).The ischial tuberosity is the most common site. 2009 Jul;37(7):1370-4 •Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes. We report a case of a 56-year-old healthy man who sustained an acute osseous avulsion of the adductor sleeve complex on the left side, which was surgically repaired with bone anchors and a … Descriptive laboratory study. Another stress-related injury in the femoral region is the adductor insertion avulsion syndrome, also known as “thigh splints” [1, 2]. This syndrome is thought to represent an avulsive injury of the proximal femoral shaft related to one or more of the adductor muscles that insert in this region. bony avulsion of the base of the proximal pha-lanx. Significant ecchymosis and a palpable defect may be present at the medial aspect of the ischial tuberosity. Pain typically localises to the proximal adductor longus insertion and is provoked by shooting, passing, running, and ‘cutting’ (a rapid change in direction when running). Attachments of Adductor Magnus: Origin and Insertion. Sona Pungavkar. proximal adductor magnus avulsion. A 31-year-old male athlete with adductor longus (AL) proximal tendon avulsion and detachment of the rectus abdominis-adductor longus (RA-AL) aponeurosis. A2 – Skier’s thumb. Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries: A Prospective Cohort Study. This phenomenon occurs when there is a UCL tear that results in entrapment of the adductor pollicis aponeurosis within the UCL. Proximal adductor avulsions are rarely isolated but usually involve injury to the PLAC and pectineus: descriptive MRI findings in 145 athletes Knee Surg Sports Traumatol Arthrosc . Avulsion fractures of the ulnar corner of the proximal phalangeal base of the thumb are treated in a fashion similar to the other proximal phalanges. It was successfully managed by minimally invasive extensor hallucis brevis tenodesis. Associated rectus abdominis injuries were rare and only occurred in five patients (3.5%). Figure 2 – Adductor muscle insertion onto D1 Proximal phalanx that can obstruct proximal portion of UCL ligament . Reports of isolated proximal avulsion of the adductor magnus are less common. This article describes our surgical technique for management of a rare acute proximal adductor magnus avulsion. H ip adduction is accomplished through coordinated effort of the adductor magnus, brevis, and longus and the obturator externus and pectineus muscles. 48 athletes with a PLAC injury had a partial pectineus avulsion. Proximal hamstring tendinopathy and avulsion injuries - assessment & treatment with Benoy Mathew Proximal hamstring tendinopathy is common in runners and athletes.
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