Per Hölmich

Background: Groin pain remains a major challenge in sports medicine. Aim: To examine 207 consecutive athletes (196 men, 11 women) with groin pain using a standardised and reliable clinical examination programme that focused on signs that suggest pathology in (1) the adductors, (2) the ilopsoas and (3) the rectus abdominis. Patients and methods: Most patients were football players (66%) and runners (18%). In this cohort, the clinical pattern consistent with adductor-related dysfunction, was the primary clinical entity in 58% of the patients and in 69% of the football players. Iliopsoas-related dysfunction was the primary clinical entity in 36% of the patients. Rectus abdominis-related dysfunction was found in 20 (10%) patients but it was associated with adductor-related pain in 18 of these patients. Multiple clinical entities were found in 69 (33%) patients; of these, 16 patients had three clinical entities. Conclusions: These descriptive data extend previous findings that physical examination for groin pain can be reliable. While underscoring the prevalence of adductor-related physical examination abnormality in football players, the data highlight the prevalence of examination findings localising to the iliopsoas among this cohort. Also, the fact that combinations of clinical entities were present has important implications for treatment. The finding of multiple abnormal clinical entities also raises the possibility that earlier presentation may be prudent; it is tempting to speculate that one clinical entity likely precedes other developing entities. These data argue for the need for a trial where clinical entities are correlated with systematic investigation including MRI and ultrasonography.

Die Differentialdiagnose des Leisten- und Hüftschmerzes ist auch im Hinblick auf die Überlagerung durch vertebragene, intestinale, urogenitale und neurogene Ursachen eine anspruchsvolle Aufgabe. Eine systematische Untersuchung der Hüft- und Leistenregion ist entscheidend, um zur korrekten Diagnose zu gelangen. Bereits die Anamneseerhebung und körperliche Untersuchung kann bereits in vielen Fällen richtungweisend sein, die Röntgendiagnostik und ggf. eine Injektion an den Ort der pathologischen Veränderung vervollständigen den Untersuchungsalgorithmus. Im vorliegenden Beitrag werden typische Symptome des Hüft- und Leistenbereichs beschrieben und einzelnen Verletzungen und Erkrankungen zugeordnet. Es folgt eine detaillierte Erklärung der klinischen Untersuchung einschließlich einer genauen Beschreibung der gängigen Funktionstests auf ein positives Impingement und Apprehension, Adduktoren- und Psoasprobleme, Psoas- und Traktusschnappen, Verkürzung der Gelenkkapsel und periartikulären Muskulatur, eine weiche Leiste, schmerzhaft veränderte Ansätze der Bauchmuskulatur und hüftübergreifenden Muskulatur. The differential diagnosis of hip and groin pain with respect to the high frequency of referred pain from the lumbar spine, lower abdomen, and pelvis is demanding. A systematic approach to the hip and groin area is important to identify the origin of pain. Both the history and quality of symptoms and the physical exam are the basics of the diagnostic algorithm. Roentgenograms and possibly an injection with a local anesthetic to the suspected origin of pain often complete the diagnostic work-up. The following report summarizes the typical symptoms of hip and groin disorders. A detailed description of the physical exam including functional tests for impingement, apprehension, adductor-, psoas-, and inguinal-related pain is included.

Background: Groin pain is a diagnostic and therapeutic challenge to sports medicine. The literature provides no consensus on definitions of or diagnostic criteria for groin pain in athletes. To compare the results of research and treatments, the methods used to diagnose and evaluate the degree of groin pain must be clearly defined and reproducible. Objectives: To describe clinical examination techniques for groin pain in athletes and evaluate the intraobserver and interobserver reliability of these. Methods: Eighteen athletes, nine with sports related groin pain and nine without groin pain, were examined by two doctors and two physiotherapists. The examiners were trained in the examination techniques before the study. The examiners were blinded to the symptoms and identity of the subjects. The subjects were examined twice by each examiner in random order. The examinations included evaluation of adductor muscle related pain and strength, iliopsoas muscle related pain, strength, and flexibility, abdominal muscle related pain, and strength and pain at the symphysis joint. Kappa statistics and percentage of agreement were used to evaluate the data. Results: Overall, the κ values and percentage of agreement were in accordance and showed good reliability of the examinations. The κ values for the intraobserver agreement were above 0.60 in 11 of 14 tests, and those for the interobserver agreement of the pain tests were above 0.60 in eight of 10 tests. The only test without acceptable interobserver reliability was the strength test for iliopsoas muscle. Conclusion: All but one of the tests investigated were reproducible and subject only to limited intraobserver and interobserver variation.