Adductor tendonitis is just one of many possible diagnoses of groin pain in runners or sportspeople. In a previous blog, Dr. Masci discussed the causes of groin pain. In most cases, groin pain is due to an overload of the tendons and joints surrounding the pubic symphysis. The treatment of this groin pain, also known as pubic overload, consists of a progressive exercise program. However, some patients fail to settle with therapy. So what are the options for these more complex cases of adductor tendonitis? Some doctors recommend an injection such as an adductor tendonitis injection. But how effective are injections?

What injections are appropriate for groin pain?

Generally, it depends on the cause of groin pain. If the reason is pubic overload or osteitis pubis, injection into a groin tendon or joint may be possible. For example, if a person has adductor tendonitis, then performing an adductor tendonitis injection makes sense. Alternatively, an ultrasound-guided pubic symphysis injection, also known as osteitis pubis injection, would be better if the pain arising from this joint. Moreover, if groin pain originates from the hip joint, then a hip joint injection would be better.

It is essential to understand that injections should only be used as an addition to a rehab program. They do not replace exercise therapy and should not be thought of as a quick fix.

What are the different injections available for adductor tendonitis?

The most common injection performed for adductor tendonitis is a cortisone injection in adductor tendon. Cortisone is a potent inflammatory drug that reduces pain in tendonitis. In a previous blog, Dr. Masci discusses cortisone injections for tendonitis and has written a review paper on injections in tendonitis. Although cortisone is a reasonable option for adductor tendonitis, we need to be aware of the possible adverse effects of cortisone on tendons, including tendon weakening and skin side effects.

More recently, PRP or platelet-rich plasma has been used for groin pain. We obtain PRP from whole blood, spun and separated from the red and white cells. The plasma is then injected into a tendon or joint. Dr. Masci discusses the pros and cons of PRP injections in a previous blog. Although groin specialists use PRP to help with adductor tendonitis and other causes of groin pain, there is little evidence of effectiveness.

Cortisone or PRP injections into tendons or joints in the groin are usually done under ultrasound guidance. In general, ultrasound allows greater accuracy and reduced side effects.

Apart from cortisone and PRP, are there other adductor tendonitis injection options?

Perhaps yes. Recently, groin specialists have been using nerve injections to reduce groin pain. The pain-relieving effect lasts for weeks to months and can help when people are stuck. For example, we can perform an injection targeting the obturator nerve in the adductor muscle group to relieve pain from adductor tendonitis. Alternatively, an injection targeting the nerves of the abdominal wall helps with pain arising from the pubic symphysis joint. In that way, we can obtain a pain-relieving effect without directly injecting a tendon or joint, and thus we think these injections are safer. On occasion, nerve injections are combined with tendon or joint injections for a more significant effect. In general, most groin specialists perform nerve injections with ultrasound.

How does a nerve injection produce pain relief in a tendon in the groin?

Generally, we think that stunning the nerves temporarily with a local anesthetic reduces the pain messages going to your brain. This has the effect of changing nerve pathways in your brain, producing a more prolonged effect than the numbing effect of the local anesthetic. Also, some doctors add a small dose of cortisone, which has the added effect of reducing nerve inflammation. So we get pain relief without the risks of injecting the tendon directly with harmful substances like cortisone.

The image below is an example of an obturator nerve injection. We position the tip of the needle in the exact location of the nerve.

adductor tendonitis injection under ultrasound

Final word from Sportsdoctorlondon about adductor tendon injection options

In general, groin specialists perform injections for groin pain to reduce pain. Adductor tendon or osteitis pubis injections using either cortisone or PRP may be helpful in some cases. We use nerve injections to reduce pain without the potential side effects common in tendon or joint injections. Overall, injections are only performed in combination with a rehab program.

Other hip and groin conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.