Working Diagnosis:
Adductor Insertion Avulsion Syndrome (Thigh Splint)

Treatment:
She was restricted from running for two weeks and given crutches to assist with ambulation.

Outcome:
After a two-week period of strict rest and non-weight bearing, the athlete progressed to light activity, including walking, stretching, range of motion exercises, and stationary bicycling. Once pain-free, she began formal physical therapy and gradually returned to running.

Author's Comments:
None

Editor's Comments:
Adductor Insertion Avulsion syndrome is thought to represent an early response to bone stress in the femur. It is a periostitis that occurs where the adductor longus and brevis insert into the femur. A rapid increase in training volume or new activities can lead to bone fatigue due to increased loading or muscle forces resulting from abnormal biomechanics. Pain that progresses to occur with daily ambulation suggest a more serious injury. While bone stress injuries of the femoral neck are more common, this case highlights that other regions of the femur are also susceptible to bone stress injury. MRI finding progress from a periostitis to bone marrow edema, cortical edema, and finally fracture as the stress continues. Relative rest allows for healing of the bone, while physical therapy or other guidance to improve mechanics is important to allow an athlete to progress back to activity without re-accumulation of stress.

References:
Anderson MW, Kaplan PA, Dussault RG. Adductor Insertion Avulsion Syndrome (Thigh Splints) Spectrum of MR Imaging Features. Am J Roentgenol. 2001;177:673-675.

Tasdelen N, Altintas F, Gurses, Kara HD, Kilickesmez NO, Gurmen AN. Adductor Insertion Avulsion Syndrome (Thigh Splints): Diagnosis With MRI Follow-Up. Yeditepe Med J. 2008;6:75-78.

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