Abstract
Adductor insertion avulsion syndrome, also known as thigh splints, is an uncommon condition that can mimic primary bone tumors or osteomyelitis.
This article describes the clinical and imaging findings of adductor insertion avulsion syndrome in a 14-year-old male long-distance runner. The patient presented with a 1-month history of progressively worsening pain in the medial aspect of the left thigh. No significant findings were noted on physical examination except slight tenderness to palpation. Radiographs revealed an intracortical radiolucent lesion with a solid periosteal reaction in the medial aspect of the femoral diaphysis. Bone scintigraphy showed an increased uptake corresponding with the lesion of the left medial femoral diaphysis. Computed tomography confirmed the presence of periosteal reaction and intracortical linear hypoattenuation and showed no fracture line. Magnetic resonance imaging revealed periosteal, cortical, and intramedullary signal intensity abnormalities. These clinical and radiologic features suggested adductor insertion avulsion syndrome. The patient was treated with initial avoidance of weight bearing using 2 crutches for ambulation, followed by progressive weight bearing over a period of 2 weeks. The symptom resolved completely 7 weeks after initial evaluation, and the patient had normal gait without pain.
Knowledge of this condition is important for the appropriate interpretation of imaging findings and the avoidance of unnecessary biopsy with potentially misleading results. Moreover, this case provides a time line as a reference for the rehabilitation of patients in similar cases.
- 1.Anderson MW, Kaplan PA, Dussault RG. Adductor insertion avulsion syndrome (thigh splints): spectrum of MR imaging features. AJR Am J Roentgenol. 2001; 177(3):673–675. Crossref Medline, Google Scholar
- 2.Charkes ND, Siddhivarn N, Schneck CD. Bone scanning in the adductor insertion avulsion syndrome (“thigh splints”). J Nucl Med. 1987; 28(12):1835–1838. Medline, Google Scholar
- 3.Anderson SE, Johnston JO, O’Donnell R, Steinbach LS. MR imaging of sports-related pseudotumor in children: mid femoral diaphyseal periostitis at insertion site of adductor musculature. AJR Am J Roentgenol. 2001; 176(5):1227–1231. Crossref Medline, Google Scholar
- 4.Ozburn MS, Nichols JW. Pubic ramus and adductor insertion stress fractures in female basic trainees. Mil Med. 1981; 146(5):332–334. Crossref Medline, Google Scholar
- 5.Armfield DR, Kim DH, Towers JD, Bradley JP, Robertson DD. Sports-related muscle injury in the lower extremity. Clin Sports Med. 2006; 25(4):803–842.
10.1016/j.csm.2006.06.011 Crossref Medline, Google Scholar - 6.Mulligan ME. The “gray cortex”: an early sign of stress fracture. Skeletal Radiol. 1995; 24(3):201–203.
10.1007/BF00228923 Crossref Medline, Google Scholar - 7.Civelek AC, Scott WW, Urban BA, Lietman SA. Thigh splints in a young female soccer player. Clin Nucl Med. 2001; 26(4):341–343.
10.1097/00003072-200104000-00013 Crossref Medline, Google Scholar - 8.Singh AK, Dickinson C, Dworkin HJ, Adductor insertion avulsion syndrome. Clin Nucl Med. 2001; 26(8):709–711.
10.1097/00003072-200108000-00012 Crossref Medline, Google Scholar - 9.Robinson P, Barron DA, Parsons W, Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 2004; 33(8):451–457.
10.1007/s00256-004-0753-2 Crossref Medline, Google Scholar - 10.Weaver JS, Jacobson JA, Jamadar DA, Hayes CW. Sonographic findings of adductor insertion avulsion syndrome with magnetic resonance imaging correlation. J Ultrasound Med. 2003; 22(4):403–407. Crossref Medline, Google Scholar
- 11.Sofka CM, Marx R, Adler RS. Utility of sonography for the diagnosis of adductor avulsion injury (“thigh splints”). J Ultrasound Med. 2006; 25(7):913–916. Crossref Medline, Google Scholar
- 12.Tshering-Vogel D, Waldherr C, Schindera ST, Adductor insertion avulsion syndrome, “thigh splints”: relevance of radiological follow-up. Skeletal Radiol. 2005; 34(6):355–358.
10.1007/s00256-004-0864-9 Crossref Medline, Google Scholar - 13.Chai JW, Hong SH, Choi JY, Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Radiographics. 2010; 30(3):737–749.
10.1148/rg.303095120 Crossref Medline, Google Scholar - 14.López-Barea F, Hardisson D, Rodríguez-Peralto JL, Sánchez-Herrera S, Lamas M. Intracortical hemangioma of bone. Report of two cases and review of the literature. J Bone Joint Surg Am. 1998; 80(11):1673–1678. Crossref Medline, Google Scholar
- 15.Griffith JF, Kumta SM, Chow LT, Leung PC, Metreweli C. Intracortical osteosarcoma. Skeletal Radiol. 1998; 27(4):228–232.
10.1007/s002560050372 Crossref Medline, Google Scholar - 16.Hermann G, Klein MJ, Springfield D, Abdelwahab IF, Dan SJ. Intracortical osteosarcoma; two-year delay in diagnosis. Skeletal Radiol. 2002; 31(10):592–596.
10.1007/s00256-002-0532-x Crossref Medline, Google Scholar
