Maximus Gage
The adductor muscle group is a large muscle group, comprising 22.5% of the mass of the lower extremity. It includes the pectineus, adductor brevis, adductor longus, adductor magnus, and gracilis. These muscles are located in the medial compartment of the thigh, and their function is to pull the thighs together and rotate the upper leg inwards, as well as stabilising the hip. Palpation of the adductors is a technique used to assess and diagnose adductor strain or tightness, and can be performed by a specialist or clinician.
| Characteristics | Values |
|---|---|
| Muscle bellies | Adductor longus, gracilis, and adductor magnus |
| Origin | Pubic tubercle (adductor longus), ischiopubic ramus (gracilis and adductor magnus) |
| Acute phase | Active adduction range of motion and manual resistance to adduction will increase the patient's pain |
| Chronic phase | Assessment is done by palpating for global tightness of adductor musculature and/or myofascial trigger points or fascial adhesion |
| Position | Side-lying |
| Test | Adduction of the underneath extremity from the table without rotation, flexion, or extension of the hip, or tilting of the pelvis |
| Strength | Graded by pressure applied over the medial aspect of the thigh in the direction of abduction |
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What You'll Learn
Palpating the adductor longus
To palpate the adductor longus, start by identifying the structure that becomes visible during passive abduction of the hip, which is the adductor longus itself. Its origin at the pubic tubercle can be felt as a strong cord. The gracilis, located posterior to the adductor longus and slightly more lateral, can also be palpated. As a bi-articular structure, the gracilis and adductor longus become more stretched when the knee is extended during passive hip abduction. This causes the broad and flat tendon on the ischiopubic ramus to press against the palpating finger.
During the acute phase of an adductor strain, palpation can help identify the area of strain and further elicit pain. The adductor longus' proximal tendon can be used as a landmark for palpation as it has a prominent proximal tendon. The pectineus lies directly lateral to it, while the gracilis lies directly medial, and the adductor magnus is posterior to the gracilis. Additionally, resistance to adduction of the thigh can be applied, with the other hand placed on the distal medial thigh, to confirm engagement of the musculature.
Once the acute stage has passed and the adductor strain has become chronic, palpation can be used to assess for global tightness of the adductor musculature, myofascial trigger points, or fascial adhesion. Stretching the adductor musculature may also reveal decreased abduction range of motion, and possibly extension or flexion, depending on whether anterior or posterior adductor fibers are strained. A postural exam may also be useful to identify knock knees or a high iliac crest on the affected side due to increased thigh adduction.
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Palpating the adductor magnus
The adductor magnus is the largest, most powerful, and most complex muscle of the adductor group. It is a hip adductor and is divided into an adductor (pubofemoral) portion and a hamstring (ischiocondylar) portion. The adductor magnus muscle has a dual role as a dynamic stabilizer of the pelvis and femur, and as a prime mover of the femur into adduction.
Palpation is most successfully performed by dropping immediately off the pubic bone and then resisting the patient from adducting the thigh at the hip joint against resistance, feeling for the engagement of the musculature. During the acute phase of an adductor strain, swelling will also be palpable and possibly visible. Active adduction range of motion and manual resistance to adduction will increase the patient's pain. These tests will most likely also be positive for thigh flexion or extension if the adductor magnus is involved.
Once the acute stage of an adductor strain has resolved and the condition is chronic, assessment is usually done by palpating for global tightness of adductor musculature and/or myofascial trigger points or fascial adhesion. Stretching the adductor musculature will also usually result in a decreased range of motion into abduction, and perhaps extension or flexion depending on whether it is anterior or posterior adductor fibres that are strained.
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Palpating the gracilis
To palpate the gracilis, ask the patient to adduct the bottom hip. The gracilis muscle is located in the medial thigh compartment, so the palpation should focus on this area. Place your hand on the medial side of the thigh, just above the knee, and feel for the muscle. You can also ask the patient to hold while you provide a push on the bottom thigh in the direction of hip abduction to increase the contraction of the gracilis.
The gracilis muscle is the only adductor of the thigh that crosses and acts on two joints: the hip and the knee. It originates from the ischiopubic ramus and extends to the tibia. The muscle fibres blend into a round tendon, which passes through the medial condyle of the femur and then fans out around the medial condyle of the tibia. At this point, it joins the pes anserinus, a conjoined tendon comprising the tendons of the gracilis, sartorius, and semitendinosus muscles.
It is important to note that the gracilis muscle is prone to strain injuries, especially in athletes who participate in sports such as soccer, hockey, football, and basketball. During the acute phase of a strain, palpation of the affected area will elicit pain. Additionally, swelling may be palpable and possibly visible. To determine the extent of the strain, a postural exam may be conducted to check for genu valgus (knock knees) or a high iliac crest on the affected side.
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Assessing adductor strain
Adductor strain is a common injury among physically active individuals, especially in competitive sports such as football, soccer, hockey, and basketball. The adductor muscles are a group of muscles that run from the pelvic bone down to the inner thigh and knee, enabling the hip and leg to move inward across the body and stabilising the trunk.
To assess adductor strain, it is essential to understand the grading system for strains: Grade 1 is a mild strain with slight pulling and minor tearing, but no loss of strength or change in muscle and tendon length. Grade 2 is a moderate strain with tearing of fibres within the muscle or tendon, resulting in a loss of strength and increased length. Grade 3 is a full tear, which is rare.
When palpating for adductor strain, it is important to identify the correct muscles. The adductor longus, for example, has a prominent proximal tendon that can be used as a landmark. The pectineus lies lateral to it, the gracilis medial to it, the adductor magnus posterior to the gracilis, and the adductor brevis is usually located deep to the longus. During the acute phase of a strain, swelling may be palpable or even visible, and manual resistance to adduction will increase the patient's pain.
To assess adductor strength, the adductor squeeze test is often used. This test is performed with the patient lying supine and their legs at 0°, 45°, and 90° of hip flexion. The examiner places their fist between the patient's knees, and the patient is instructed to squeeze the fist, contracting the adductor muscles maximally. This test is particularly useful for screening for adductor muscle weakness and reducing the risk of groin injuries, as weakness in these muscles is an intrinsic risk factor for such injuries.
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Adductor muscle anatomy
The adductor muscles are a group of muscles in the medial compartment of the thigh that are responsible for thigh adduction and gait stabilization. They are also known as the hip adductors, inner thigh muscles, or muscles of the medial compartment of the thigh. This muscle group is made up of five muscles: pectineus, adductor brevis, adductor longus, adductor magnus, and gracilis. These muscles extend from the anteroinferior external surface of the bony pelvis to the shaft of the femur and proximal tibia.
The adductor muscle group is a very large muscle group, making up 22.5% of the mass of the lower extremity. They originate at the pubis and the ischium (the lower portions of the pelvis or hipbone) and are attached along the femur (thighbone). Their primary action is adduction of the thigh, such as when squeezing the thighs together. They also aid in rotation and flexion of the thigh.
The adductor magnus is unique in its functions, contributing to hip extension and external rotation. The other adductor muscles are considered anterior and have similar functions, contributing to hip flexion and internal rotation. The gracilis, in particular, crosses the knee and may contribute to knee flexion and internal rotation.
The adductor muscles are susceptible to strain, which can cause pain and swelling. During the acute phase of an adductor strain, palpation, active adduction range of motion, and manual resistance to adduction will increase the patient's pain. Once the acute stage has passed, assessment is typically done by palpating for global tightness of adductor musculature and/or myofascial trigger points or fascial adhesion.
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Frequently asked questions
Palpation is a method used to assess a client with an adductor strain. It involves feeling for the engagement of the musculature to confirm that the correct area is being examined.
The adductor muscles are a large muscle group, comprising 22.5% of the mass of the lower extremity. They are located in the medial compartment of the thigh, from the pubis to the knee. To palpate the adductor muscles, you can start by placing your hand on the distal medial thigh and resisting the client from adducting the thigh at the hip joint. The adductor longus, gracilis, and adductor magnus can be palpated at the medial side of the thigh.
The adductor muscles, also known as hip adductors or inner thigh muscles, include the pectineus, adductor brevis, adductor longus, adductor magnus, and gracilis. These muscles are responsible for pulling the thighs together and rotating the upper leg inwards, as well as stabilizing the hip.
During the acute phase of an adductor strain, the client may experience increased pain during active adduction and manual resistance to adduction. There may also be swelling that is palpable or visible. In the chronic phase, assessment is done by palpating for global tightness of the adductor musculature and/or myofascial trigger points.
