title: Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?
abstract: BACKGROUND
  Little is known about the value of clinical examination in relation to diagnostic imaging for acute groin injuries in athletes. Primary aim: to investigate whether clinical examination tests predict a positive or negative MRI result (MRI±). Secondary aim: to assess accuracy of clinical tests to localise injury in MRI+ cases.
  
  
  METHODS
  We consecutively included 81 male athletes with acute groin injuries. Standardised clinical examination (palpation, resistance and stretch tests) and MRI were performed within 7 days of injury. Diagnostic statistics including positive and negative predictive values (PPV/NPV) were calculated.
  
  
  RESULTS
  85 acute injuries were found on MRI in 64 (79%) athletes with 17 (21%) athletes having MRI- injuries. Palpation had the highest NPV (91-96%, (95% CI 69% to 99%)). 3 specific adductor examination tests (resisted outer range adduction, squeeze test with hip neutral and long lever, and passive adductor stretch) showed 80-81% (95% CI 63% to 91%) probability of an MRI+ adductor lesion when positive, all with high accuracy of a correct MRI location (PPV 93-97% (95% CI 76% to 100%)). Hip flexor tests showed poor ability to predict MRI+ lesions (PPV 34-63% (95% CI 20% to 84%)) and low accuracy (PPV 17-71% (95% CI 7% to 85%)).
  
  
  CONCLUSIONS
  21% of athletes had negative imaging and the absence of palpation pain was best at predicting an MRI- result. Specific adductor examination tests accurately predicted MRI+ adductor injuries. Hip flexor clinical tests were poor at predicating and localising MRI+ injuries in the hip flexors. Clinical examination appears sufficient to diagnose acute adductor injuries, whereas MRI could assist in accurately locating acute hip flexor injuries.
authors.affiliation: Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.|Sports Orthopaedic Research Center (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Andreas
authors.initials: A
authors.lastname: Serner
authors.affiliation: Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Adam
authors.initials: A
authors.lastname: Weir
authors.affiliation: Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.|Academic Center for Evidence Based Sports Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Johannes L
authors.initials: JL
authors.lastname: Tol
authors.affiliation: Sports Orthopaedic Research Center (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorborg
authors.affiliation: Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, Boston, Massachusetts, USA.|Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Roemer
authors.affiliation: Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Guermazi
authors.affiliation: Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.|Sports Orthopaedic Research Center (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Hölmich
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006119:Groin / Q000293:injuries*; D025981:Hip Injuries / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D055815:Young Adult
keywords: Diagnosis; Examination; Groin; Radiology; Sport