Torn adductor magnus

[grinder]

This might be a new one, I can't find any other examples of this on the internet. It first started 15 years ago when I hammered on my bike out of my driveway without properly warming up, so I had to stop riding for 2 weeks. If I gradually work into activity and do proper warmups it seems to be OK (no longer though!). Over the last year it has gotten significantly worse, with at least 2 episodes, the first of which lasted 2 months. I am now 2.5 months into the second one. The problem is that when I pull it I don't feel the pain until 3 days later when it's too late. I have now learned to recognize the sensation and immediately stop. That provides little comfort now as I am almost bed ridden. I have pulled it about 10 times over the last 2.5 months and every time it gets worse.

About 3 days to a week later the inflammation goes away, the pain dissipates and I become happy but then easily pull it again since it is so weak. A month ago I was in my chair and bent over to pick up my shoes and badly pulled it, as it was under stretch. I felt it go and the pain was immediate. I think I now have a bad lesion on the muscle and it is degenerating. It can no longer walk and I can't even use crutches since to hold my leg up I need to use that muscle. I have to drag my leg behind me on the ground, I may need to put a wheel on my shoe for any mobility. I am off work now and almost totally helpless. I have moved into my mom's house with the intention of lying in bed for 3 weeks. But the problem is that I even pull it at night by extending my leg from bent to straight. I can't use the muscle at all even for the gentlest movements. I am now splinting it up at night to prevent me from pulling it but it is still very easy to tear it.

I went to physio last month but it was misdiagnosed as tendonitis and she got me to do exercises which made it worse and since then it has been a downhill spiral. I supposedly will be seeing a sports doctor this month, after a 2 month waiting list.

It will get better, I know this (I hope), with proper discipline. However, I can't find any examples of this injury anywhere. It is on the lower adductor magnus, about 5 inches up from where it attaches to the adductor tubercle. There is probably also some tendinosis involved too. This muscle flexes considerably on leg extension. When it acts up also have a deeper pain (like getting kicked in the nuts) around the back of my knee, which I attribute to the portion of the adductor magnus that attaches to the femur further up. From the lower adductor tubercle the medial collateral ligaments go down to the tibia, and I also get short lived pain in these. These three symptoms go together, never mutually exclusive. There is little pain on touch, except after I tear it and it is inflamed.

Has anyone ever heard of this? It is incredibly frustrating, I see it just go downhill, it is (has) ruined my life. I have fallen off the cliff now where just everyday activities are enough to make it worse and I don't want it to get worse or I'll lose it!

[Heidi]

Hi
I'm sorry to hear of your problem.
I think this is quite a complex problem, possibly beyond the scope of this forum and your best bet is to wait to speak to the sports doctor. I think an MRI scan is required to really see what is going on. It may be only muscular, but could also involve nerve injury.
Let us know what results you get from the sports doctor

[grinder]

I finally went in to see the doctor last week and he fully agreed with my assessment. He said it is the worst pulled muscle he has seen. However, in his examination, he told me to do the pushes and pulls of my thigh to assess the strength. I don't know why I agreed to do that since I promised myself that I would not allow myself to be hurt again. My leg had actually improved the day before to where most of the pain had gone. But he made me do the knee squeeze and holy cow have I been feeling it in the week since. Right on cue, 2.5 days later the pain started and it hasn't gone away yet, 5 days later. I got a brace for night time but this doesn't seem to help much. In the last 2 nights I have awoken at 4 am with excruciating pain in the tendon area attached to the muscle. I have to take it off. I don't know if there is any position that will allow me to rest it enough for it to heal now since it seems to have crossed the point of no return. However, I may be pleasantly surprised at some point in the near future because it usually does eventually heal up after the pulls, this being the 11th one, ready to be pulled yet again! But it has never been this bad.

I am very angry that this has been allowed to progress so far, particularly at my physiotherapist. I went in there complaining of this pain and she decided I had a pulled adductor. We also thought I had tendonitis, because the distal tendon is obviously more stringly than the other leg. Well, that wasn't tendonitis, that was because I had torn the muscle off of it, exposing the tendon!!!!! So she gets me to do exercises. Everything I read on the internet tells you to do nothing with your muscle if you have pulled it. I would think it would be the first thing you learn in physiotherapy school. If you are complaining of sharp stabbing pain, do not do exercises unless you are certain of what the problem is!!! I felt uneasy about the exercises but because of my tendency to accept authority I did it anyways. And also because of this, afterwards I was not as careful to stay off my leg, since they all seemed to be recommending I continue using my leg. She should have ordered me to stay off it until the pain had gone away for weeks, and then return.

And when it got to the point where I simply couldn't even limp on it any more and I had to use crutches, I called her up and told her of this and she said to just hang in there, stay off it, and wait for the doctor's appointment a month down the road. Well in that month it really went downhill.

And then my doctor, knowing full well my injury, makes me do these thigh squeezes and makes it even worse!

But above all I am angry at myself for trusting the medical professionals when instead I should have taken charge of the situation myself and trusted my own diagnosis which was right, and made way more noise and demanded to see a doctor much earlier on.

This is a never ending nightmare and I am wondering if I am ever going to get over it.

[grinder]

I went to see my new doctor who lives closer to my mom since I now have to live with her so she can take care of me. It now seems apparent that this is a nerve injury, in addition to a muscle tear. It took 2 weeks to get over the intense pain after my first doctor made me do the knee squeeze. During that time almost any movement was excruciating. I finally got to the point where I wasn't in constant pain and went in to see my new doctor and as usual, he tried to make me do the leg movements. He seemed to disagree that it was a mere muscle tear since I am not doing anything anymore to tear it. It seems to be nerve damage. Interestingly, in playing with my other leg he really wrenched on my other hip adductor and gave me some sharp pain that I haven't recovered from yet. But it is exactly how this injury started. I guess I have a susceptibility to this injury. It actually started last month on the good leg recently because I was getting up from the ground using that leg solely and it was pulling the muscle.

So I guess on my bad leg I pulled the muscle originally and along with this went the nerve. There is definitely less muscle on the distal tendon attached to the adductor tubercle. And now it's so weak, the muscle has greatly wasted, and I keep re-pulling the nerve that goes through there.

So what I now need to learn about is how the nerve goes through there. Are there other cases of pulling muscles and at the same time nerves?

In the last few days my foot has started to get tingly, and it gets very cold and swollen and purple.

The nerve does heal itself if I am careful not to use my leg for several days. But I guess it is much weaker than the muscle and if I am not careful it easily pulls again. It is a delicate dance I have to do, to keep myself from reinjuring the nerve long enough for it to regain its strength and be able to withstand muscle contraction. But one thing's for sure, it sure can't handle any more doctors pushing and pulling on my leg. I am supposedly going to see a muscle rehabilitator, I'm not sure exactly what he does. But I will not let him do anything to my leg other than poking it.

[grinder]

After EMG it was discovered that I have femoral nerve damage (neuropathy). My quads were becoming very weak, almost paralyzed, and this is why my leg was buckling. I guess the nerve also sends branches to those parts of my leg where I was feeling pain. However, I get no symptoms with the saphenous nerve, which is a sensory offshoot that goes down to the lower leg. This may mean that the problem is below this branch, or maybe not.

I have now regained the ability to walk short distances, although this constitutes me using my leg as a peg and limping, but at least it's a start and keeps my foot active. And my quads regained semi-normal firing ability so I can now flex them. So, I presume this means there is no permanent damage, and once the lesion heals up I will return to normal.

However, we still don't know where and why the nerve is being damaged. The MRI revealed edema in the psoas muscle (which the femoral nerve actually passes through). I do have a lot of weakness and pain and damage which takes a week to heal from when lifting my leg, which is the action of the psoas, so right now I am leaning towards a problem in the psoas muscle.

I am sure this is an injury from improper training and warming up. Interestingly, the symptoms are coming to my other leg (again, only after I ask it to make a lot of force) because I haven't been training it at all and sometimes when I ask it to go up or down stairs this is quite a bit of effort and I don't warm the muscle up and I "pull" it, so I think this is some susceptibility I have to the problem. Of course I will not let the other leg get to the degree of pathology my right leg has reached. And I HAVE to guard it against over zealous medical people. They don't realize the damage they can cause.

[grinder]

Also, when I mentioned before about the muscle being pulled off my ischiocondylar tendon on the lower adductor magnus, what I think I was seeing was instead such atrophy of the quadriceps that the vastus medialus was no longer covering that tendon and it felt naked to the touch. It seems to be regaining some of its mass now. However, it seems coincidental that all of this pain was happening right there, and that's where I was noticing anatomical changes.... if it's a nerve problem further up in the pelvis, then the pain should be diffuse and not correlated with any damage in the same area. I am sure I was pulling that muscle. Maybe there was more than one problem going on, which always makes it so much more difficult top diagnose. But these symptoms all act up and diminish together. Weird... I just don't get it. Nothing really makes perfect sense, it doesn't fit into any previous record I can find. And then, if I'm careful and don't move my leg for 2 weeks, all the pain just magically vanishes. Then I use it again too early (presumably before the nerve has regained its physical strength to withstand muscle motion) and inevitably twang the nerve again and the cycle repeats, over and over and over again ... that sounds like an entrapped nerve to me.

Also, sorry for my raging in the earlier post, although it was partially warranted. This is at times (after aggravation) a very painful and frightening condition and it's taken so far a half year of my life away, and may take a full year after all is said and done. My mom has to cook for me and take care of me. I watch TV, go on the internet and read. I can barely walk now but it makes my leg worse so why bother? It's better to sit there and do nothing! Holy cow when I get over this I will appreciate my freedom. It's frustrating too, because otherwise I am in 100% perfect health, I was an athlete doing the Grouse Grind hiking trail in Vancouver in 30 minutes, near record time. Now I can barely move! Oh well, that's life, sometimes bad things happen, and it could definitely be much worse.

[grinder]

I have finally figured out what the problem was. And for the last 3 weeks I have been able to walk, although it's not pretty.

I have always had tight hamstrings. Apparently this was somehow damaging my femoral nerve in my femoral triangle. This is why over the last 15 years I have had episodes of this problem, but nowhere near this degree of disability. I don't understand the specific mechanics of how this was happening but I think the tight hamstrings were pulling a side nerve (a branch of the saphenous nerve maybe) away from the main trunk, resulting in a lesion at the junction which caused problems everywhere below. Simply stretching my hamstrings alleviates the problem. All this time I was only 2 weeks away from recovery......

The black hole I fell into was that in order to allow the nerve to heal after I or the doctors hurt it, I had to not move my leg for 2 weeks. But this lack of movement made my hamstrings get even tighter, and therefore as soon as I started moving my leg again I pulled the nerve again and the cycle repeated itself many many times. Until I realized how tight my hamstrings were and selectively targeted stretching there, I couldn't get better.

So .... my tight hamstrings were pulling on my femoral nerve in the femoral triangle, which was causing partial paralysis in my quads and pain down my inner thigh, and in later stages, lots of inflammation and muscle pain in the femoral triangle area (I still have this, which is preventing me from walking properly). The iliopsoas muscle might also have something to do with it. The inflammation and edema in my femoral triangle (revealed by the MRI) which developed as a result of the nerve damage (revealed by the EMG) was compressing the femoral artery and vein which are right beside the nerve, which then restricted blood flow to my leg, and explains why my foot got so cold and purple and was developing skin problems and lesions as would a diabetic with poor circulation.

http://en.wikipedia.org/wiki/Femoral_triangle

The only reference I have been able to find for any of this is a vague one here to nerve entrapment in the femoral triangle because the nerve is unprotected there and there's tendons and muscles going everywhere:

http://emedicine.medscape.com/article/1234809-overview

"Most entrapment neuropathies occur below the inguinal ligament. After passing beneath the inguinal ligament, the femoral nerve is in close proximity to the femoral head, the tendon insertion of the vastus intermedius, the psoas tendon, the hip, and the joint capsule. The femoral nerve does not have significant protection in this area."

This is also helpful:

http://emedicine.medscape.com/article/1141793-overview

I now have a lot of rehab work to do as a result of 5 months of muscle and ligament atrophy. My leg at its worst was extremely skinny but it's improving substantially. I should be able to walk normally in a few weeks I imagine but it will be a few months before I can get up to any athletic ability again. I'm going to seriously start a regular stretching and yoga program. I did stretch a lot before this happened, but I guess my hamstring stretches weren't good enough. And now that I know what the problem is it will never return! I will be able to get back up to 100% because there's nothing else wrong with me or my joints! I still don't know exactly what was happening but it was obviously due to tight muscles, so a stretching program will fix it. That's all I need to know now; I don't want to think about it anymore.

I should also tell my doctor what was wrong with me. Despite him telling me last time that although he didn't know what the problem was, it wasn't actually nerve entrapment as I was suggesting, and I wasn't actually experiencing the symptoms that I was experiencing, and wrenching on the leg wasn't actually causing problems......

A valuable lesson I guess ---- be your own doctor. Use the internet and your symptoms as your primary source, and use doctors as potentially helpful resources.

[Heidi]

Thanks grinder. Thats really interesting and useful.

I'm glad you are on the mend and good luck with your rehabilitation.