Clinical examination tests for adductor- and pubic-related groin pain in athletes with longstanding groin pain: Inter-examiner reliability and prevalence of positive tests

Objectives: Evaluate the inter-examiner reliability of pain provocation tests for hip adductors (palpation, stretch and resistance) and for pubic symphysis (palpation) in athletes with longstanding groin pain, and to determine the prevalence of positive tests. Design: Inter-examiner reliability. Setting: Orthopaedic and sports medicine hospital. Participants: Male athletes with longstanding groin pain. Main outcome measures: Inter-examiner reliability, absolute/positive/negative agreement, and the mean prevalence of positive tests for athletes classified with adductor- and pubic-related groin pain were calculated. Results: We included 44 male athletes with longstanding groin pain (61 symptomatic sides). The mean age was 29 years (+/- 6) and 70% were soccer players. Inter-examiner reliability was slight to moderate for adductor palpation (Cohen's Kappa statistic(kappa)) = 0.02-0.54) and pubic palpation (kappa = 0.37-0.45); moderate for the adductor stretch test (kappa = 0.50), and fair to substantial for adductor resistance tests (kappa = 0.22-0.74). Palpation pain was most prevalent at the adductor longus origin (94%) in athletes classified with adductor-related groin pain. Conclusion: The inter-examiner reliability of palpation tests varied from slight to moderate. The adductor stretch test had a moderate reliability, and adductor resistance tests a fair to substantial reliability. Adductor longus origin is the main site for palpation pain. Adductor palpation tests not related to the adductor longus have limited inter-examiner reliability. The adductor stretch test did not assist in classifying adductor-related groin pain.