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Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?
  1. Andreas Serner1,2,
  2. Adam Weir1,
  3. Johannes L Tol1,3,
  4. Kristian Thorborg2,
  5. Frank Roemer4,5,
  6. Ali Guermazi4,
  7. Per Hölmich1,2
  1. 1Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2Sports Orthopaedic Research Center (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  3. 3Academic Center for Evidence Based Sports Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
  1. Correspondence to Andreas Serner, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha 29222, Qatar; andreas.serner{at}


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.

  • Groin
  • Diagnosis
  • Radiology
  • Examination
  • Sport

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  • Twitter Follow Andreas Serner at @aserner

  • Contributors AS, AW, JLT, KT and PH contributed to the conception and design of the study. All authors contributed to the analysis and interpretation of the data. AS drafted the article, and all authors revised it critically and approved the final article.

  • Funding The study was funded by Aspetar Orthopaedic and Sports Medicine Hospital.

  • Competing interests Outside this work, AG has received consultancies, speaking fees and/or honoraria from Sanofi-Aventis, Merck Serono and TissuGene, and is President and shareholder of Boston Imaging Core Lab (BICL), LLC, a company providing image assessment services. FR is Chief Medical Officer and shareholder of BICL, LLC.

  • Ethics approval Shafallah Medical Genetics Center and the Anti-Doping Laboratory Qatar Institutional Review Boards (IRB project no. 2012-013 and EXT2014000004).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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