Diagnosis of longstanding groin pain in athletes

Longstanding groin pain is a common and challenging condition in athletes. Chapter 1 introduces its epidemiology, groin anatomy, diagnostic challenges, existing classification systems, and treatment approaches. In Chapter 2, a Delphi study and international survey revealed that five years after publication, the Doha agreement classification system is widely adopted, indicating good perceived clinical utility, though diagnostic terminology remains heterogeneous. Chapter 3 assessed the inter-examiner reliability of the classification system in 48 male athletes, showing reliability ranged from slight to substantial, with better agreement for single-entity diagnoses. Chapter 4 focused on inguinal-related groin pain, evaluating the reliability of palpation and resistance tests in 44 athletes. Results showed fair to moderate reliability for most tests, with scrotal invagination during Valsalva being the most prevalent positive test. Chapter 5 examined the inter-examiner reliability of tests for adductor- and pubic-related groin pain. Reliability ranged from slight to substantial, with adductor longus palpation pain being the most common finding. Due to a low number of pubic-related cases, conclusions for this entity were limited. Chapter 6 established normative hip strength and range of motion values in elite female football players. Older players had higher strength values but lower external and total hip rotation. No relevant differences were found based on playing position or leg dominance. Chapter 7 provides an overarching discussion, clinical recommendations, and directions for future research to enhance diagnostic accuracy and management of longstanding groin pain in athletes.