Clinical examination for athletes with inguinal-related groin pain: interexaminer reliability and prevalence of positive tests

Willem M P Heijboer; Zarko Vuckovic; Adam Weir; Johannes L Tol; Per Hölmich; Andreas Serner

doi:https://doi.org/10.1136/bmjsem-2022-001498

Clinical examination for athletes with inguinal-related groin pain: interexaminer reliability and prevalence of positive tests

Willem M P Heijboer, Zarko Vuckovic, Adam Weir, Johannes L Tol, Per Hölmich, Andreas Serner

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: To evaluate the interexaminer reliability of abdominal palpation and resistance tests in athletes with longstanding groin pain, and to identify the prevalence of positive clinical tests in athletes classified with inguinal-related groin pain.

METHODS: Male athletes (18-40 years) with longstanding groin pain were prospectively recruited between March 2019 and October 2020 at a sports medicine hospital. Two examiners performed history taking and standardised clinical examination (including abdominal palpation, scrotal invagination and abdominal resistance tests) blinded to each other's findings. Interexaminer reliability was calculated using Cohen's Kappa statistic (κ). Examiners classified groin pain using the Doha agreement meeting terminology. A differentiation was made between 'defined inguinal-related groin pain' (according to recommended definition criteria) and 'likely inguinal-related groin pain' (expert-based application of the Doha agreement classification when not all recommended criteria were present).

RESULTS: Overall, 44 athletes were included (61 symptomatic sides). Interexaminer reliability of inguinal palpation pain provocation tests varied from fair to moderate (κ=0.35-0.49). Reliability of posterior wall structure palpation (firm/soft) was slight (κ=0.01), and posterior wall bulging (yes/no) fair (κ=0.29). Reliability for abdominal resistance tests varied from fair to substantial (κ=0.35-0.72). In athletes classified with defined inguinal-related groin pain, recognisable injury pain on palpation during scrotal invagination when athletes performed a Valsalva manoeuvre was the most prevalent positive palpation test (79%). Abdominal resistance tests were positive in 21%-49% of these cases.

CONCLUSION: The interexaminer reliability for clinical examination tests used to classify inguinal-related groin pain in athletes varies from slight to substantial. There is no single perfect clinical examination test.

TRIAL REGISTRATION NUMBER: NCT03842826.

Original language	English
Pages (from-to)	e001498
Journal	BMJ Open Sport and Exercise Medicine
Volume	9
Issue number	1
DOIs	https://doi.org/10.1136/bmjsem-2022-001498
Publication status	Published - 2023

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https://doi.org/10.1136/bmjsem-2022-001498

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@article{4ba6266f9446473b83c50618c19925c0,

title = "Clinical examination for athletes with inguinal-related groin pain: interexaminer reliability and prevalence of positive tests",

abstract = "OBJECTIVES: To evaluate the interexaminer reliability of abdominal palpation and resistance tests in athletes with longstanding groin pain, and to identify the prevalence of positive clinical tests in athletes classified with inguinal-related groin pain.METHODS: Male athletes (18-40 years) with longstanding groin pain were prospectively recruited between March 2019 and October 2020 at a sports medicine hospital. Two examiners performed history taking and standardised clinical examination (including abdominal palpation, scrotal invagination and abdominal resistance tests) blinded to each other's findings. Interexaminer reliability was calculated using Cohen's Kappa statistic (κ). Examiners classified groin pain using the Doha agreement meeting terminology. A differentiation was made between 'defined inguinal-related groin pain' (according to recommended definition criteria) and 'likely inguinal-related groin pain' (expert-based application of the Doha agreement classification when not all recommended criteria were present).RESULTS: Overall, 44 athletes were included (61 symptomatic sides). Interexaminer reliability of inguinal palpation pain provocation tests varied from fair to moderate (κ=0.35-0.49). Reliability of posterior wall structure palpation (firm/soft) was slight (κ=0.01), and posterior wall bulging (yes/no) fair (κ=0.29). Reliability for abdominal resistance tests varied from fair to substantial (κ=0.35-0.72). In athletes classified with defined inguinal-related groin pain, recognisable injury pain on palpation during scrotal invagination when athletes performed a Valsalva manoeuvre was the most prevalent positive palpation test (79%). Abdominal resistance tests were positive in 21%-49% of these cases.CONCLUSION: The interexaminer reliability for clinical examination tests used to classify inguinal-related groin pain in athletes varies from slight to substantial. There is no single perfect clinical examination test.TRIAL REGISTRATION NUMBER: NCT03842826.",

author = "Heijboer, {Willem M P} and Zarko Vuckovic and Adam Weir and Tol, {Johannes L} and Per H{\"o}lmich and Andreas Serner",

note = "{\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

doi = "https://doi.org/10.1136/bmjsem-2022-001498",

language = "English",

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pages = "e001498",

journal = "BMJ Open Sport and Exercise Medicine",

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TY - JOUR

T1 - Clinical examination for athletes with inguinal-related groin pain

T2 - interexaminer reliability and prevalence of positive tests

AU - Heijboer, Willem M P

AU - Vuckovic, Zarko

AU - Weir, Adam

AU - Tol, Johannes L

AU - Hölmich, Per

AU - Serner, Andreas

PY - 2023

Y1 - 2023

N2 - OBJECTIVES: To evaluate the interexaminer reliability of abdominal palpation and resistance tests in athletes with longstanding groin pain, and to identify the prevalence of positive clinical tests in athletes classified with inguinal-related groin pain.METHODS: Male athletes (18-40 years) with longstanding groin pain were prospectively recruited between March 2019 and October 2020 at a sports medicine hospital. Two examiners performed history taking and standardised clinical examination (including abdominal palpation, scrotal invagination and abdominal resistance tests) blinded to each other's findings. Interexaminer reliability was calculated using Cohen's Kappa statistic (κ). Examiners classified groin pain using the Doha agreement meeting terminology. A differentiation was made between 'defined inguinal-related groin pain' (according to recommended definition criteria) and 'likely inguinal-related groin pain' (expert-based application of the Doha agreement classification when not all recommended criteria were present).RESULTS: Overall, 44 athletes were included (61 symptomatic sides). Interexaminer reliability of inguinal palpation pain provocation tests varied from fair to moderate (κ=0.35-0.49). Reliability of posterior wall structure palpation (firm/soft) was slight (κ=0.01), and posterior wall bulging (yes/no) fair (κ=0.29). Reliability for abdominal resistance tests varied from fair to substantial (κ=0.35-0.72). In athletes classified with defined inguinal-related groin pain, recognisable injury pain on palpation during scrotal invagination when athletes performed a Valsalva manoeuvre was the most prevalent positive palpation test (79%). Abdominal resistance tests were positive in 21%-49% of these cases.CONCLUSION: The interexaminer reliability for clinical examination tests used to classify inguinal-related groin pain in athletes varies from slight to substantial. There is no single perfect clinical examination test.TRIAL REGISTRATION NUMBER: NCT03842826.

AB - OBJECTIVES: To evaluate the interexaminer reliability of abdominal palpation and resistance tests in athletes with longstanding groin pain, and to identify the prevalence of positive clinical tests in athletes classified with inguinal-related groin pain.METHODS: Male athletes (18-40 years) with longstanding groin pain were prospectively recruited between March 2019 and October 2020 at a sports medicine hospital. Two examiners performed history taking and standardised clinical examination (including abdominal palpation, scrotal invagination and abdominal resistance tests) blinded to each other's findings. Interexaminer reliability was calculated using Cohen's Kappa statistic (κ). Examiners classified groin pain using the Doha agreement meeting terminology. A differentiation was made between 'defined inguinal-related groin pain' (according to recommended definition criteria) and 'likely inguinal-related groin pain' (expert-based application of the Doha agreement classification when not all recommended criteria were present).RESULTS: Overall, 44 athletes were included (61 symptomatic sides). Interexaminer reliability of inguinal palpation pain provocation tests varied from fair to moderate (κ=0.35-0.49). Reliability of posterior wall structure palpation (firm/soft) was slight (κ=0.01), and posterior wall bulging (yes/no) fair (κ=0.29). Reliability for abdominal resistance tests varied from fair to substantial (κ=0.35-0.72). In athletes classified with defined inguinal-related groin pain, recognisable injury pain on palpation during scrotal invagination when athletes performed a Valsalva manoeuvre was the most prevalent positive palpation test (79%). Abdominal resistance tests were positive in 21%-49% of these cases.CONCLUSION: The interexaminer reliability for clinical examination tests used to classify inguinal-related groin pain in athletes varies from slight to substantial. There is no single perfect clinical examination test.TRIAL REGISTRATION NUMBER: NCT03842826.

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DO - https://doi.org/10.1136/bmjsem-2022-001498

M3 - Article

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SN - 2055-7647

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JO - BMJ Open Sport and Exercise Medicine

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