Resisted adduction in hip neutral is a superior provocation test to assess adductor longus pain: An experimental pain study

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 degrees had the greatest positive likelihood ratio (+LR=2.8, 95%CI: 1.09-7.32) with 45 degrees (-LR=0.0, 95%CI: 0.00-1.90) and 90 degrees (-LR=0.0, 95%CI: 0.00-0.94) having the lowest negative LR. This study indicates that the 0 degrees 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.