title: Resisted adduction in hip neutral is a superior provocation test to assess adductor longus pain: An experimental pain study.
abstract: The criterion of long-standing groin pain diagnoses in athletes usually relies on palpation and clinical tests. An experimental pain model was developed to examine the clinical tests under standardized conditions. Pain was induced by hypertonic saline injected into the proximal adductor longus (AL) tendon or rectus femoris (RF) tendon in 15 healthy male participants. Isotonic saline was injected contralaterally as a control. Pain intensity was assessed on a visual analog scale (VAS). Resisted hip adduction at three different angles and trunk flexion were completed before, during, and after injections. Pain provocation in the presence of experimental pain was recorded as a true positive compared with pain provocation in the non-pain conditions. Similar peak VAS scores were found after hypertonic saline injections into the AL and RF and both induced higher VAS scores than isotonic saline (P < 0.01). Adduction at 0° had the greatest positive likelihood ratio (+LR = 2.8, 95%CI: 1.09-7.32) with 45° (-LR = 0.0, 95%CI: 0.00-1.90) and 90° (-LR = 0.0, 95%CI: 0.00-0.94) having the lowest negative LR. This study indicates that the 0° hip adduction test resisted at the ankles optimizes the diagnostic procedure without compromising diagnostic capacity to identify experimental groin pain. Validation in clinical populations is warranted.
authors.affiliation: School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.|Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia.
authors.forename: M K
authors.initials: MK
authors.lastname: Drew
authors.affiliation: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.
authors.forename: T S
authors.initials: TS
authors.lastname: Palsson
authors.affiliation: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.|Department of Orthopedic Surgery, Kochi University, Kochi, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Izumi
authors.affiliation: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.
authors.forename: R P
authors.initials: RP
authors.lastname: Hirata
authors.affiliation: Department of Sports Medicine, Australian Institute of Sport, Canberra, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Lovell
authors.affiliation: School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Chiarelli
authors.affiliation: School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
authors.forename: P G
authors.initials: PG
authors.lastname: Osmotherly
authors.affiliation: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Graven-Nielsen
mesh_terms: D000328:Adult; D006119:Groin; D006615:Hip; D006801:Humans; D007552:Isotonic Solutions / Q000494:pharmacology; D016013:Likelihood Functions; D008297:Male; D009119:Muscle Contraction; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement; D056888:Patient Positioning; D010808:Physical Examination / Q000379:methods*; D012372:ROC Curve; D012462:Saline Solution, Hypertonic / Q000494:pharmacology; D013710:Tendons / Q000187:drug effects / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic
keywords: Groin; athlete; diagnostic test; experimental pain; pain