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Special tests library › How common is it?

How common is it?

Starting probabilities by setting: how often each condition turned out to be the diagnosis among patients seen in first contact (GP or physio), sports medicine, emergency departments and specialist clinics, from 260 checked figures for 94 conditions.

Starting estimates for groups of patients in published studies, not the person in front of you. Adjust for age, history and your own caseload.

How to read these figures

These figures show how often each condition turned out to be the diagnosis among people who came to a particular kind of clinic with a particular problem. They vary a lot by setting and by how patients were selected: the same condition can be rare among everyone seen by a GP but common among people already suspected of it, sent for an MRI, or referred to a specialist. Pick the row whose setting and 'who' description best match the patient in front of you, and treat the figure as a rough starting point, not a precise number. Figures marked 'abstract source only' were checked against the published abstract but not the full paper. Starting figures are the first step in clinical reasoning, to be adjusted by the history, examination and tests; they are not a diagnosis tool and do not replace clinical judgement.

The specialist column is shown for context: many test accuracy studies were done in specialist clinics, where the condition is usually more common than in first contact. Groups already going to surgery or arthroscopy are marked ‘surgical series’. To use a starting figure with a test’s likelihood ratios, see the probability calculator. Figures checked 16 Oct 2026.

Jump to: Neck · Shoulder · Elbow · Wrist/hand · Thoracic/chest wall · Low back/pelvis · Hip/groin · Knee · Ankle/foot

Neck

Cervical radiculopathy (nerve root pain from the neck)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 32% (27/85) Suspected radiculopathy, neurosurgery department, France. Grondin 2021, n=85 [suspected radiculopathy; consecutive; abstract source only]
  • 37% Suspected radiculopathy, Dutch multidisciplinary clinic. Sleijser-Koehorst 2021, n=134 [suspected radiculopathy; figure from Thoomes 2026 review table, not the primary abstract]
  • 50% (67/135) Neck pain, hospital pain clinic, had MRI. Park 2017, n=135 [had MRI; retrospective; abstract source only]

Cervicogenic headache

First contact (GP or physio)
  • 54% (63/117) Direct-access physical medicine and rehabilitation (doctor-led) clinic, Turkey, neck pain with forward head posture, age 18-45. Usen 2025, n=117 [narrow group: young adults with forward head posture; international headache classification (ICHD-3) clinical criteria, not block-confirmed]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 27% (27/100) Chronic neck pain (over 3 months) after car-crash whiplash, referred to a research clinic, Newcastle, Australia. Lord 1994, n=100 [third occipital nerve (C2-3) headache only, double nerve-block confirmed; other neck sources not tested, so a minimum for cervicogenic headache; 53% when headache was the main complaint]
  • 33% (10/30) Headache with neck pain, headache clinic. Getsoian 2020, n=30 [small convenience sample; nerve-block confirmed; abstract source only]

Rule It In, Rule It Out shows how to use these starting points with the tests.

Shoulder

Subacromial pain (impingement / rotator cuff tendinopathy)

First contact (GP or physio)
  • 34% (66/196) New shoulder pain, GP or physio, NZ. Cadogan 2011, n=208 [defined by injection response; clinical diagnosis gives higher figures]
  • at least 54% (139/255) Shoulder pain, 14 physio clinics, Canada. Carter 2012, n=255 [lower bound: both physios agreed; neck pain and surgical candidates excluded; abstract source only]
  • 41% Shoulder pain, Dutch primary-care physio. Karel 2019, n=389 [physio's working diagnosis (examination, ultrasound in 31%); abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 36% (275/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [main diagnosis only]
  • 41% (412/1001) Shoulder surgeons' private practice, Brazil. Malavolta 2017, n=1001 [cuff tendinopathy; plus 11% partial cuff tears]

Full-thickness rotator cuff tear

First contact (GP or physio)
  • about 5% (10/203) New shoulder pain, GP or physio, NZ. Cadogan 2011, n=208 [young group (mean age 42); supraspinatus tears on ultrasound]
  • 8% Adults GP sent for shoulder ultrasound. Ottenheijm 2014, n=240 [only those sent for ultrasound; predefined sample of 240 reports (20 per month)]
Sports medicine

No good study

Emergency department
  • 4% All suspected shoulder injuries, Oslo casualty. Enger 2018, n=3031 [any cuff tear (full or partial), diagnosed clinically with MRI in selected cases, so likely under-counted; denominator is injuries; abstract source only]
  • 32% (38/120) Age 40+, acute shoulder injury, no fracture on X-ray, Oslo emergency/walk-in clinic, seen at follow-up within 3 weeks. Enger 2025, n=120 [normal X-ray; ultrasound screened; 38% including 8 hidden avulsion fractures]
  • 32% (33/104) Can't lift arm, normal X-ray, Denmark. Sorensen 2007, n=104 [normal X-ray; age 19-75; abstract source only]
Specialist or orthopaedic (context)
  • 8% (58/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [14% at age 60-69, 30% over 70]
  • 12% (122/1001) Shoulder surgeons' private practice, Brazil. Malavolta 2017, n=1001

Acromioclavicular (AC) joint pain or injury

First contact (GP or physio)
  • 14% (22/153) New shoulder pain, GP or physio, NZ. Cadogan 2013, n=153 [defined by X-ray-guided injection response; 98% physio-referred]
  • at least 7.8% (20/255) Shoulder pain, 14 physio clinics, Canada. Carter 2012, n=255 [lower bound: both physios agreed; abstract source only]
  • 24% (31/131) Shoulder pain, 2 UK general practices, seen in a rheumatology clinic within the practices. Ostor 2005, n=131 [clinical diagnosis by a rheumatology doctor; patients could have more than one diagnosis (77% did); the paper's own table gives a different figure, 40 patients (31%)]
Sports medicine
  • 45% (60/133) College football quarterback shoulder injuries. Tummala 2018, n=133 [team injury records; AC sprains; denominator is injuries; abstract source only]
  • 30% (14/47) Irish schoolboy rugby shoulder injuries. Leahy 2021, n=47 [team injury records; denominator is match injuries; all AC joint injuries 34% (16/47)]
Emergency department
  • 17% (8/48) Acute shoulder trauma, normal X-ray, France. Saragaglia 2021, n=48 [normal X-ray; MRI at 7-14 days; small; abstract source only]
Specialist or orthopaedic (context)
  • 4% (31/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [AC arthritis as main diagnosis only (under-counted); plus 0.9% (7) AC joint ruptures]
  • 1.4% (14/1001) Shoulder surgeons' private practice, Brazil. Malavolta 2017, n=1001 [AC arthrosis as main diagnosis; plus 0.8% chronic AC dislocation]
  • 74% (28/38) Pain mapped to AC joint, shoulder service. Walton 2004, n=38 [highly selected; injection-confirmed; abstract source only]

Shoulder dislocation or anterior instability

First contact (GP or physio)

No good study

Sports medicine
  • 5% (7/133) College football quarterback shoulder injuries. Tummala 2018, n=133 [team injury records; anterior instability; abstract source only]
  • 34% (16/47) Irish schoolboy rugby shoulder injuries. Leahy 2021, n=47 [team injury records; dislocation or subluxation; denominator is match injuries]
  • 29% US high-school athletes' shoulder injuries, 9 sports. Robinson 2014, n=2798 [team injury records; dislocation and AC separation combined; abstract source only]
Emergency department
  • 17% All suspected shoulder injuries, Oslo casualty. Enger 2018, n=3031 [includes AC and sternoclavicular dislocations; denominator is injuries; abstract source only]
  • 6% (3/48) Acute shoulder trauma, normal X-ray, France. Saragaglia 2021, n=48 [normal X-ray; anterior dislocations/subluxations that had already gone back; plus 1 posterior (8% any direction); abstract source only]
Specialist or orthopaedic (context)
  • 2.5% (19/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [anterior labral tear/instability]
  • 8% (81/1001) Shoulder surgeons' private practice, Brazil. Malavolta 2017, n=1001 [instability in any direction; acute dislocations excluded]

Frozen shoulder (adhesive capsulitis)

First contact (GP or physio)
  • 15% (20/131) Shoulder pain, 2 UK general practices, seen in a rheumatology clinic within the practices. Ostor 2005, n=131 [clinical diagnosis by a rheumatology doctor; patients could have more than one diagnosis (77% did)]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 11% (86/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [most common at age 40-70]
  • 13.5% (135/1001) Shoulder surgeons' private practice, Brazil. Malavolta 2017, n=1001

Calcific tendinopathy

First contact (GP or physio)
  • 13% (26/203) New shoulder pain, GP or physio, NZ. Cadogan 2011, n=208 [calcium deposit on X-ray, not proof it causes pain; 24% (49/203) had cuff calcification on ultrasound]
  • 29% Adults GP sent for shoulder ultrasound. Ottenheijm 2014, n=240 [only those sent for ultrasound; ultrasound finding]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 3.6% (36/1001) Shoulder surgeons' private practice, Brazil. Malavolta 2017, n=1001 [main diagnosis only]

SLAP lesion (top of the labrum)

First contact (GP or physio)
  • at least 9.6% (20/208) New shoulder pain, GP or physio, NZ. Cadogan 2011, n=208 [lower bound: MR arthrogram only in 93 non-responders; imaging lesion]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 32% (30/93) Surgeon unsure after history, tertiary clinics. Somerville 2017, n=93 [selected: SLAP uncertain after history; Type II 13%]
  • 2.1% (16/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [main diagnosis only]
  • 3.2% (32/1001) Shoulder surgeons' private practice, Brazil. Malavolta 2017, n=1001

Labral tear (any)

First contact (GP or physio)
  • at least 21% (44/208) New shoulder pain, GP or physio, NZ. Cadogan 2011, n=208 [lower bound: MR arthrogram only in 93 non-responders; imaging lesion]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 5.2% (40/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [main diagnosis only; 9 with multidirectional instability (no tear) not counted; none over age 50]

Posterior labral tear

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 0.7% (5/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [all posterior tears, main diagnosis only]
  • 17% (30/172) Painful shoulders having arthroscopy, Seoul. Kim 2005, n=172 [surgical series; posteroinferior lesions; abstract source only]

Shoulder pain referred from the neck

First contact (GP or physio)
  • 7% (9/131) Shoulder pain, 2 UK general practices, seen in a rheumatology clinic within the practices. Ostor 2005, n=131 [pain spreading from the neck into the C5/6 dermatome; rheumatology doctor's diagnosis; patients could have more than one diagnosis (only 2 had this alone); the paper's own table gives a different figure, 8 patients (6%)]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 2.9% (22/766) All shoulder referrals, hospital clinic, Oslo. Juel 2014, n=766 [includes 5 (0.7%) with cervical radiculopathy]
  • 5% GP patients, community rheumatology clinic, UK. Vecchio 1995, n=not stated [n not stated in abstract; abstract source only]

Rule It In, Rule It Out shows how to use these starting points with the tests.

Elbow

Elbow fracture after an elbow injury

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 31% (538/1740) Acute elbow injury, 5 English EDs. Appelboam 2008, n=1740 [adults 33% (316/958); children 29% (222/778); fracture totals include 25 dislocations]
  • 35% (38/110) Acute elbow injury X-rayed, US ED. Docherty 2002, n=110 [any bone or joint injury; abstract source only]
  • 34% (24/70) Acute elbow injury, Greek A&E. Lamprakis 2007, n=70 [includes dislocations; small; abstract source only]
Specialist or orthopaedic (context)

No good study

Radial head fracture

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 21% (204/958) Adults with acute elbow injury, English EDs. Appelboam 2008, n=958 [23% radial head or neck (222/958)]
  • 5% (38/778) Children with acute elbow injury, English EDs. Appelboam 2008, n=778 [age 3-15]
Specialist or orthopaedic (context)

No good study

Supracondylar fracture (children)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 14% (106/778) Children with acute elbow injury, English EDs. Appelboam 2008, n=778 [age 3-15; 48% of children's elbow fractures]
Specialist or orthopaedic (context)

No good study

Tennis elbow (lateral elbow tendinopathy)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 53% (451/847) Elbow complaints (mostly adults, mean age 48), one elbow surgeon's clinic, Brazil. Zanesco 2025, n=847 [one main diagnosis per patient; acute fractures excluded; Brazil]

Golfer's elbow (medial elbow tendinopathy)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 16% (137/847) Elbow complaints (mostly adults, mean age 48), one elbow surgeon's clinic, Brazil. Zanesco 2025, n=847 [one main diagnosis per patient; acute fractures excluded; Brazil]

Cubital tunnel syndrome (ulnar nerve at the elbow)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 4.4% (37/847) Elbow complaints (mostly adults, mean age 48), one elbow surgeon's clinic, Brazil. Zanesco 2025, n=847 [nerve studies not stated as reference]

Complete distal biceps tendon rupture

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 14% (18/125) Elbow pain, one shoulder/elbow surgeon, Boston. Bono 2021, n=125 [only those with MRI or surgery kept; any biceps tear 23% (29/125)]
  • 49% (42/86) Suspected biceps injury, Dutch clinics and EDs. Zwerus 2022, n=86 [suspected biceps injury; 91% men]

Distal biceps tendinopathy (no rupture)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 1.6% (14/847) Elbow complaints (mostly adults, mean age 48), one elbow surgeon's clinic, Brazil. Zanesco 2025, n=847

Elbow instability (including posterolateral rotatory instability)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 3.5% (30/847) Elbow complaints (mostly adults, mean age 48), one elbow surgeon's clinic, Brazil. Zanesco 2025, n=847 [all instability types together]
  • 31% (13/42) Persistent lateral elbow pain going to arthroscopy. Mahasupachai 2026, n=42 [surgical series; failed treatment; posterolateral rotatory instability; abstract source only]

Ulnar collateral ligament (UCL) injury

First contact (GP or physio)

No good study

Sports medicine
  • 35% (95/274) Children and teens (mean age 12.5) with medial elbow injury, sports clinic. Sinha 2024, n=274 [complete UCL disruption, includes 62 bony avulsions seen on X-ray; any UCL injury below growth plate 55% (150/274); MRI not in all; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 81% (17/21) Surgery for medial pain from valgus overload. O'Driscoll 2005, n=21 [surgical series; tiny; abstract source only]

Rule It In, Rule It Out shows how to use these starting points with the tests.

Wrist/hand

Wrist fracture (any) after a wrist injury

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 53% (470/882) Adults with acute wrist injury, 5 Dutch EDs. Walenkamp 2015, n=882
  • 42% Blunt wrist injury X-rayed, Dutch ED. van den Brand 2013, n=1019 [of those X-rayed (91%); rate highest in children and older adults (about 20% even in lower-risk groups); abstract source only]
Specialist or orthopaedic (context)

No good study

Distal radius fracture after a wrist injury

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 44% (384/882) Adults with acute wrist injury, 5 Dutch EDs. Walenkamp 2015, n=882
  • about 41% (320/787) Children 3-17 with wrist injury, Dutch EDs. Slaar 2016, n=787 [320 distal radius fractures among 787 children; a further 42 'forearm' fractures not split by bone; any distal forearm fracture 46% (364/787)]
Specialist or orthopaedic (context)

No good study

Scaphoid fracture

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 7.6% (68/893) All adults with acute wrist injury, Dutch EDs. Mallee 2020, n=893 [all wrist injuries; 54 seen first visit, 14 at follow-up]
  • 28% (62/223) Suspected or X-ray-confirmed scaphoid injury, Edinburgh trauma unit. Duckworth 2012, n=223 [includes fractures already seen on first X-ray; X-ray follow-up only, no routine MRI; whether seen in ED or fracture clinic not stated; abstract source only]
  • 18% (44/248) Suspected scaphoid fracture, UK district hospital. Downs 2025, n=248 [suspected scaphoid; abstract source only]
Specialist or orthopaedic (context)
  • 24% (130/537) Fracture clinic referrals, suspected scaphoid injury. Burns 2013, n=537 [suspected scaphoid; 76% never proven to have a fracture; abstract source only]

Hidden (occult) scaphoid fracture with a normal first X-ray

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 9.0% Suspected scaphoid, normal X-ray, 8 studies. Coventry 2023, n=1685 [normal X-ray; systematic review; n = wrist injuries; abstract source only]
  • 12.9% (256/1989) Normal X-ray, early MRI, 8 UK centres. Dean 2024, n=1989 [normal X-ray; had MRI; retrospective; abstract source only]
  • 10.4% (7/67) Suspected scaphoid, normal X-ray, immediate MRI. Rua 2019, n=67 [normal X-ray; had MRI; another 22% had a different fracture; abstract source only]
Specialist or orthopaedic (context)
  • 22% (43/197) Referred, normal X-ray, positive scaphoid test, Queensland. Burton 2025, n=197 [normal X-ray; had MRI; another 30% had a different hidden fracture; abstract source only]
  • 9.6% (43/450) Fracture clinic referrals not seen on X-ray. Burns 2013, n=450 [normal first X-ray; no routine MRI; abstract source only]

Hidden (occult) wrist fracture in children with a normal X-ray

First contact (GP or physio)
  • 48% (29/60) Children under 16, GP-requested MRI, Queensland. Jones 2015, n=60 [suspected scaphoid; normal X-ray; had MRI; any carpal, metacarpal or radius fracture; abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Scapholunate ligament injury

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 13% (18/137) Suspected scaphoid, normal X-ray, orthopaedic referrals. Tibrewal 2012, n=137 [normal X-ray; had MRI; any intercarpal ligament injury, not proven instability; abstract source only]
  • 31% (317/1021) Everyone having wrist MRI, US hospital. Kooi 2026, n=1021 [had MRI; signal change only; 264 (26% of all scanned) despite low clinical suspicion; abstract source only]

Triangular fibrocartilage complex (TFCC) tear

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 34% (46/137) Suspected scaphoid, normal X-ray, orthopaedic referrals. Tibrewal 2012, n=137 [normal X-ray; had MRI; MRI tears common without symptoms; abstract source only]
  • 59% Patients sent for wrist arthro-CT, France. Dejean-Servieres 2026, n=149 [highly selected: referred for arthro-CT; abstract source only]

Carpal tunnel syndrome

First contact (GP or physio)
  • 12% Adults with hand/wrist problem, Dutch GP. Spies-Dorgelo 2007, n=267 [broad category 'nerve entrapment', not carpal tunnel alone; 13% in the 2009 paper on the same group; abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 28% (46/167) GP referrals to plastic surgery, Canada. Incze 2026, n=167 [denominator is diagnoses (141 patients)]
  • 25% (23/93) All new surgery clinic patients, Mississippi. Thames 2025, n=93 [any complaint; 49% (23/47) of those with a hand problem]
  • about 29% Elective GP referrals to hand unit, UK. Wildin 2006, n=not stated [worked out from referral rates, not patient counts; abstract source only]

De Quervain's tenosynovitis

First contact (GP or physio)
  • 16% Adults with hand/wrist problem, Dutch GP. Spies-Dorgelo 2007, n=267 [broad category 'tenosynovitis', not De Quervain's alone; abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 2.4% (4/167) GP referrals to plastic surgery, Canada. Incze 2026, n=167 [denominator is diagnoses]
  • 2% (2/93) All new surgery clinic patients, Mississippi. Thames 2025, n=93 [any complaint]

Thumb base (CMC joint) osteoarthritis

First contact (GP or physio)
  • 17% Adults with hand/wrist problem, Dutch GP. Spies-Dorgelo 2007, n=267 [broad category: all hand/wrist osteoarthritis; abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 8.4% (14/167) GP referrals to plastic surgery, Canada. Incze 2026, n=167 [denominator is diagnoses]
  • about 9% Elective GP referrals to hand unit, UK. Wildin 2006, n=not stated [all hand OA, mostly thumb base; worked out from referral rates; abstract source only]
  • 3% (3/93) All new surgery clinic patients, Mississippi. Thames 2025, n=93 [any complaint]

Trigger finger

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 16% (27/167) GP referrals to plastic surgery, Canada. Incze 2026, n=167 [denominator is diagnoses]

Ganglion cyst

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 4.8% (8/167) GP referrals to plastic surgery, Canada. Incze 2026, n=167 [denominator is diagnoses]

Rule It In, Rule It Out shows how to use these starting points with the tests.

Thoracic/chest wall

Musculoskeletal chest wall pain (in people with chest pain)

First contact (GP or physio)
  • 47% Chest pain, age 35+, 74 German GPs. Bosner 2010, n=1212 [expert panel diagnosis; acute heart attack or unstable angina 3.6%, stable coronary heart disease another 11.1%; abstract source only]
  • 45% (300/672) All chest pain, 59 Swiss GPs. Verdon 2007, n=672 [chest wall syndrome; 43% in the 2008 paper; musculoskeletal 49%; abstract source only]
  • 49% Chest pain contacts, Reykjavik health centre. Svavarsdottir 1996, n=190 [n = contacts; retrospective; abstract source only]
Sports medicine

No good study

Emergency department
  • 38% Acute chest pain, heart cause ruled out. Stochkendahl 2012, n=302 [only after a cardiac cause was excluded; abstract source only]
Specialist or orthopaedic (context)

No good study

Costochondritis (in people with chest pain)

First contact (GP or physio)
  • 13% Chest pain episodes, US primary care network. Klinkman 1994, n=not stated [% of all diagnoses recorded in 399 episodes; separate musculoskeletal chest pain 20.4%; abstract source only]
Sports medicine

No good study

Emergency department
  • 30% (36/122) Non-traumatic chest pain, New York ED. Disla 1994, n=122 [pressing reproduced the pain in 17/122 (14%; abstract says 15%); 6% still had a heart attack; abstract source only]
Specialist or orthopaedic (context)

No good study

Rib fracture

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 24% (2071/8661) Blunt trauma over 14 who had chest X-ray and CT, US trauma-centre EDs. Murphy 2017, n=8661 [trauma-centre patients who had CT; not minor chest wall injury; abstract source only]
Specialist or orthopaedic (context)
  • 95% (56/59) Suspected rib fracture, had X-ray and CT. Vassalou 2024, n=59 [highly selected: had CT; setting not stated; abstract source only]

Thoracic spine fracture after major trauma

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 1.9% (217/11477) Blunt trauma over 14, chest imaging. Bizimungu 2020, n=11477 [major trauma centres; not people presenting with thoracic pain; abstract source only]
Specialist or orthopaedic (context)

No good study

Rule It In, Rule It Out shows how to use these starting points with the tests.

Low back/pelvis

Serious spinal pathology (any)

First contact (GP or physio)
  • 0.9% (11/1172) Acute low back pain, Sydney primary care. Henschke 2009, n=1172 [8 of 11 were fractures; abstract source only]
  • 6% Over 55, GP with back pain, Netherlands. Enthoven 2016, n=669 [mostly vertebral fractures; abstract source only]
Sports medicine

No good study

Emergency department
  • 2.5-5.1% Low back pain at EDs, 22 studies. Galliker 2020, n=41320 [needing urgent treatment; prospective studies; retrospective 0.7-7.4%; abstract source only]
Specialist or orthopaedic (context)

No good study

Vertebral (spinal) fracture

First contact (GP or physio)
  • 0.7% (8/1172) Acute low back pain, Sydney primary care. Henschke 2009, n=1172 [abstract source only]
  • 5% (33/669) Over 55, GP with back pain, Netherlands. Enthoven 2016, n=669 [all X-rayed; thoracic pain was a red flag; abstract source only]
Sports medicine

No good study

Emergency department
  • 0-7.2% Low back pain at EDs, 22 studies. Galliker 2020, n=41320 [range between studies; abstract source only]
Specialist or orthopaedic (context)

No good study

Spinal cancer (malignancy)

First contact (GP or physio)
  • 0.66% (13/1975) Back pain, walk-in clinic, San Antonio. Deyo 1988, n=1975 [old single-centre study; abstract source only]
  • 0-0.66% Primary care low back pain, 6 studies. Henschke 2013, n=6622 [range between studies; abstract source only]
Sports medicine

No good study

Emergency department
  • 0-2.1% Low back pain at EDs, 22 studies. Galliker 2020, n=41320 [range between studies; abstract source only]
Specialist or orthopaedic (context)

No good study

Spinal infection

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 0-1.9% Low back pain at EDs, 22 studies. Galliker 2020, n=41320 [range between studies; abstract source only]
Specialist or orthopaedic (context)

No good study

Cauda equina compression

First contact (GP or physio)
  • about 0.5% (3/554) GP back and leg pain, had MRI. Konstantinou 2015, n=554 [had MRI; study not designed to find cauda equina]
Sports medicine

No good study

Emergency department
  • 0.1-1.9% Low back pain at EDs, 22 studies. Galliker 2020, n=41320 [cord or cauda equina compression; all back pain presenters; abstract source only]
  • 11.6% (117/1005) Suspected cauda equina, neuroscience centre ED. Curtis Lopez 2024, n=1005 [suspected cauda equina; MRI; abstract source only]
Specialist or orthopaedic (context)
  • 13.7% (163/1188) Suspected cauda equina, regional spinal centre. Najjar 2026, n=1188 [suspected cauda equina; retrospective; abstract source only]
  • 23.7% (47/198) Suspected cauda equina, neurosurgery centre, Edinburgh. Hoeritzauer 2021, n=198 [suspected cauda equina; MRI; abstract source only]

Sciatica (nerve root pain from the back)

First contact (GP or physio)
  • 74% GP back pain plus leg pain, UK. Konstantinou 2015, n=609 [back plus leg pain only; clinical diagnosis]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Lumbar spinal stenosis

First contact (GP or physio)
  • 25% Primary care patients, pooled studies. Jensen 2020, n=not stated [clinical diagnosis; 15% by imaging; 41 papers, high risk of bias; abstract source only]
  • about 8% GP back pain plus leg pain, UK. Konstantinou 2015, n=609 [back plus leg pain only; clinical diagnosis, central or foraminal; worked out from 10.6% of the 74% with sciatica]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 29% Secondary care patients, pooled studies. Jensen 2020, n=not stated [clinical diagnosis; 32% by imaging; abstract source only]

Facet (zygapophyseal) joint pain

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 15% Consecutive chronic low back pain, USA. Schwarzer 1994, n=176 [double block confirmed; setting not stated in abstract; country taken from later papers that cite it; abstract source only]
  • 31% Chronic low back pain, academic spine centre. DePalma 2011, n=170 [dual blocks; n = cases (156 patients); abstract source only]
  • 34% Chronic low back pain, US pain practice. Manchikanti 2020, n=not stated [controlled blocks; single block gives 68%; abstract source only]

Sacroiliac joint pain

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 30% (13/43) Chronic back pain, maximal below L5-S1. Schwarzer 1995a, n=43 [single block, probably inflated; abstract source only]
  • 18.5% (10/54) Back pain with clinical SIJ pattern, Paris. Maigne 1996, n=54 [pre-selected; double block; abstract source only]
  • 18% (31/170) Chronic low back pain not settled with usual care, US academic spine centre (Virginia). DePalma 2011, n=170 [two comparative anaesthetic injections into the joint, 75%+ pain relief; n = cases (156 patients)]

Discogenic pain (internal disc disruption)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 39% Chronic back pain, no previous surgery. Schwarzer 1995b, n=92 [CT discography; setting not stated in abstract; abstract source only]
  • 42% Chronic low back pain, academic spine centre. DePalma 2011, n=170 [provocation discography; n = cases; abstract source only]
  • 22% All chronic back pain, Melbourne pain practice. Verrills 2015, n=756 [whole clinic as denominator; 223 had discography; abstract source only]

Spondylolisthesis (slipped vertebra on X-ray)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 26% (385/1458) Adults with back pain who had a lumbar X-ray, university hospital, Jordan (mean age 53). Alhosanie 2025, n=1458 [X-ray finding only, not proof of cause; women 33%, men 16%; abstract source only]

Spondylolysis (pars stress fracture) in young athletes

First contact (GP or physio)

No good study

Sports medicine
  • 47% (47/100) Athletes 12-18 with back pain, Boston. Micheli 1995, n=100 [abstract source only]
  • 42% Athletes with back pain, 9 studies. Li 2023, n=835 [pooled review; abstract source only]
  • 31% (243/782) Children 6-18 with back pain, sports centre. Iesato 2021, n=782 [pain 2+ weeks and bad enough to stop sport; X-ray, CT and MRI; Obihiro, Japan]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 5% Adults with acute back pain, orthopaedic clinic. Micheli 1995, n=100 [adult comparison group; abstract source only]

Axial spondyloarthritis

First contact (GP or physio)
  • 24% (86/364) Dutch GP, chronic back pain, age 20-45. van Hoeven 2014, n=364 [abstract source only]
  • 16% (95/579) Dutch GP, chronic back pain from before 45. van Hoeven 2015, n=579 [abstract source only]
  • 9% (6/65) Chiropractic patients pre-screened for SpA features. Deodhar 2025, n=65 [pre-screened referrals; any spondyloarthritis 12% (8/65); abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 46% (319/697) Rheumatology, back pain plus SpA feature. Deodhar 2016, n=697 [pre-selected; abstract source only]

Functional (non-structural) symptoms in suspected cauda equina

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • about 21% Suspected cauda equina, neurosurgery centre, Edinburgh. Hoeritzauer 2021, n=198 [suspected cauda equina; negative scan plus positive functional signs (68% of 61); abstract source only]

Rule It In, Rule It Out shows how to use these starting points with the tests.

Hip/groin

Hip osteoarthritis

First contact (GP or physio)
  • 44% Age 40+, new hip pain, UK GPs. Birrell 2000, n=195 [X-ray, Croft grade 2 or more; abstract source only]
  • 34% Age 40+, new hip pain, UK GPs. Birrell 2000, n=195 [more advanced change (Croft grade 3 or more); joint space under 1.5 mm about 15%; abstract source only]
  • 29% (21/72) One-sided hip pain, US Army physio. Sutlive 2008, n=72 [X-ray, Kellgren-Lawrence grade 2+; setting from author affiliation; abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Hip joint (intra-articular) source of pain

First contact (GP or physio)

No good study

Sports medicine
  • 56% Active people, chronic hip/groin pain, Belfast. Rankin 2015, n=894 [FAI, labral tear or OA; of these FAI 40%, labral 33%, OA 24%; abstract source only]
  • 11% Male athletes with groin pain, Qatar. Heijboer 2023, n=66 [hip-related; per side; most from a surgeon's groin clinic; athletes had about 3 causes each on average, so rows add to more than 100%]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 55-59% (27-29/49) Hip arthroscopy candidates given joint injection. Martin 2008, n=49 [surgical candidates; not consecutive; abstract source only]

Femoroacetabular impingement (FAI) syndrome

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 55% (83/150) Under 50, puzzling hip pain, tertiary referral. Lee 2018, n=150 [selected: undiagnosed or misdiagnosed; Korea; abstract source only]
  • 56% (139/250) Non-arthritic hip pain, tertiary centre, Ottawa. Leopold 2026, n=250 [250 of 385 consecutive with full CT and MRI; Tonnis 2+ OA excluded]

Hip dysplasia

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 13% Under 50, puzzling hip pain, tertiary referral. Lee 2018, n=150 [selected: undiagnosed or misdiagnosed; abstract source only]
  • 22% (54/250) Non-arthritic hip pain, tertiary centre, Ottawa. Leopold 2026, n=250 [250 of 385 consecutive with full CT and MRI]

Hip labral tear

First contact (GP or physio)

No good study

Sports medicine
  • 22% (4/18) Athletes with groin pain, London sports clinic. Narvani 2003, n=18 [very small; MR arthrogram; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 8.8% (22/250) Non-arthritic hip pain, tertiary centre, Ottawa. Leopold 2026, n=250 [isolated labral problem; 250 of 385 consecutive with full imaging]

Greater trochanteric pain syndrome (lateral hip pain)

First contact (GP or physio)
  • 25% Consecutive low back pain, Dutch GP. Collee 1991, n=40 [denominator is low back pain, not hip pain; diagnosed by tenderness on examination; abstract source only]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 20% (51/252) Low back pain referrals, US spine centre. Tortolani 2002, n=252 [injection-confirmed; abstract also says 247 patients; abstract source only]
  • 45% Consecutive low back pain, rheumatology clinic. Collee 1991, n=40 [denominator is low back pain; diagnosed by tenderness on examination; abstract source only]

Gluteal tendinopathy

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 50% (438/877) Referred for ultrasound, lateral hip pain. Long 2013, n=877 [ultrasound finding; bursitis 20%; abstract source only]

Gluteal tendon tear

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 46% (11/24) Women with lateral hip pain, rheumatology, Sydney. Bird 2001, n=24 [small; MRI; symptoms 12+ months; abstract source only]
  • 0.5% (4/877) Referred for ultrasound, lateral hip pain. Long 2013, n=877 [ultrasound; conflicts with Bird 2001; abstract source only]

Adductor-related groin pain

First contact (GP or physio)

No good study

Sports medicine
  • 58% Athletes with long-standing groin pain, Copenhagen. Holmich 2007, n=207 [main cause; 69% in footballers; abstract source only]
  • 61% Athletes at groin pain clinic, Qatar. Taylor 2018, n=100 [98% male; 44% had more than one cause; abstract source only]
  • 65% Male athletes with groin pain, Qatar. Heijboer 2023, n=66 [per side; most from a surgeon's groin clinic; athletes had about 3 causes each on average, so rows add to more than 100%]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Iliopsoas-related groin pain

First contact (GP or physio)

No good study

Sports medicine
  • 36% Athletes with long-standing groin pain, Copenhagen. Holmich 2007, n=207 [main cause; abstract source only]
  • 39% Male athletes with groin pain, Qatar. Heijboer 2023, n=66 [per side; most from a surgeon's groin clinic; athletes had about 3 causes each on average, so rows add to more than 100%]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 21% (134/638) Athletes with groin pain, all had MRI. Tsukada 2018, n=638 [had MRI; MRI signal change only; abstract source only]

Inguinal-related groin pain

First contact (GP or physio)

No good study

Sports medicine
  • 78% Male athletes with groin pain, Qatar. Heijboer 2023, n=66 [per side; most from a surgeon's groin clinic, which likely inflates this; athletes had about 3 causes each on average, so rows add to more than 100%]
  • 50% Athletes with chronic groin pain. Lovell 1995, n=189 [older term 'incipient hernia'; case notes; 27% had more than one cause; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Rectus abdominis-related groin pain

First contact (GP or physio)

No good study

Sports medicine
  • 10% (20/207) Athletes with long-standing groin pain, Copenhagen. Holmich 2007, n=207 [18 of 20 also had adductor pain; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Pubic-related groin pain

First contact (GP or physio)

No good study

Sports medicine
  • 4% Athletes at groin pain clinic, Qatar. Taylor 2018, n=100 [abstract source only]
  • 24% Male athletes with groin pain, Qatar. Heijboer 2023, n=48 [per person; poor agreement between examiners]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Ischiofemoral impingement

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 5.6% (14/250) Non-arthritic hip pain, tertiary centre, Ottawa. Leopold 2026, n=250 [all female; 250 of 385 consecutive with full imaging]
  • 9% (23/256) Hip/buttock pain, hip preservation clinic, Austria. Heimann 2025, n=256 [per hip (224 patients); MR arthrogram]

Piriformis syndrome (deep gluteal pain)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 17% (16/93) Chronic low back pain, hospital pain unit. Kean Chen 2013, n=93 [clinical test only, no reference standard; abstract source only]
  • 68% Unexplained sciatica after failed standard care. Filler 2005, n=239 [highly selected; single proponent group; abstract source only]

Hip or pelvic fracture after injury

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 32% (243/764) Hip pain X-rayed, one US ED. Dominguez 2005, n=764 [retrospective; includes pelvic fractures; 4.4% of normal X-rays; abstract source only]
Specialist or orthopaedic (context)

No good study

Hidden (occult) hip fracture with a normal X-ray

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 39% (1110/2835) Older adults, suspected hip fracture, normal X-ray, 35 studies. Haj-Mirzaian 2020, n=2992 [normal X-ray; selected for MRI; fractures needing surgery; 44% at 80+; abstract source only]
Specialist or orthopaedic (context)

No good study

Bone stress injury around the hip (military recruits)

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 40% (137/340) Conscripts with hip/groin pain, all had MRI. Kiuru 2003, n=340 [military recruits; had MRI; femoral neck share per patient not given; abstract source only]

Rule It In, Rule It Out shows how to use these starting points with the tests.

Knee

Anterior cruciate ligament (ACL) rupture

First contact (GP or physio)
  • 21% (28/134) Adults seeing GP after knee injury. Wagemakers 2010, n=134 [MRI; age 18-65; Netherlands; abstract source only]
  • 22% Adults 18-45, knee injury, Dutch GPs. van Oudenaarde 2017, n=174 [MRI; abstract source only]
Sports medicine
  • 20% Sports knee injuries over 10 years. Majewski 2006, n=7769 [hospital orthopaedic series; denominator is knee injuries; diagnosis method not stated; abstract source only]
Emergency department
  • 52% Acute knee injury with rapid swelling, Sweden. Olsson 2016, n=1145 [haemarthrosis only; MRI; n = knees; abstract source only]
  • 56% (89/159) Twisting injury with swelling, orthopaedic emergency. Frobell 2007, n=159 [effusion only; MRI; abstract source only]
Specialist or orthopaedic (context)
  • 52% Haemarthrosis having urgent arthroscopy, Czech. Bilik 2012, n=266 [surgical series; abstract source only]
  • 45% Haemarthrosis having acute arthroscopy, Finland. Sarimo 2002, n=320 [surgical series; abstract source only]
  • 72% (81/113) Athletes, haemarthrosis, no clinical laxity. DeHaven 1980, n=113 [surgical series; abstract source only]

Meniscal tear

First contact (GP or physio)
  • 35% (47/134) Adults seeing GP after knee injury. Wagemakers 2008, n=134 [MRI; age 18-65 (may include degenerative tears); abstract source only]
  • 15% Adults 18-45, knee injury, Dutch GPs. van Oudenaarde 2017, n=174 [MRI; traumatic tears only; abstract source only]
  • 4.7% (38/809) Age 12+, any new knee complaint, GP. van Middelkoop 2008, n=809 [GP working diagnosis; meniscus and ligament ruptures combined; acute ruptures only; a further 1.9% (15/809) coded chronic meniscal tear]
Sports medicine
  • 14.5% Sports knee injuries over 10 years. Majewski 2006, n=7769 [hospital orthopaedic series; denominator is knee injuries; abstract source only]
Emergency department
  • 41% Acute knee injury with rapid swelling, Sweden. Olsson 2016, n=1145 [haemarthrosis only; MRI; abstract source only]
Specialist or orthopaedic (context)
  • 27% Haemarthrosis having urgent arthroscopy, Czech. Bilik 2012, n=266 [surgical series; abstract source only]
  • 21% Haemarthrosis having acute arthroscopy, Finland. Sarimo 2002, n=320 [surgical series; abstract source only]
  • 15% (17/113) Athletes, haemarthrosis, no clinical laxity. DeHaven 1980, n=113 [surgical series; isolated major tears; abstract source only]

Medial collateral ligament (MCL) injury

First contact (GP or physio)
  • 26% (35/134) Adults seeing GP after knee injury. Kastelein 2008, n=134 [MRI; Netherlands; abstract source only]
Sports medicine
  • 7.9% Sports knee injuries over 10 years. Majewski 2006, n=7769 [hospital orthopaedic series; denominator is knee injuries; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 8.5% (28/331) Haemarthrosis, MRI at referral imaging service. LaPrade 2007, n=331 [haemarthrosis only; isolated superficial MCL tears only; abstract source only]

Lateral collateral ligament / posterolateral corner injury

First contact (GP or physio)

No good study

Sports medicine
  • 1.1% Sports knee injuries over 10 years. Majewski 2006, n=7769 [hospital orthopaedic series; LCL; denominator is knee injuries; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 9.1% (30/331) Haemarthrosis, MRI at referral imaging service. LaPrade 2007, n=331 [haemarthrosis only; 87% part of multi-ligament injury; isolated 1.2%; abstract source only]

Posterior cruciate ligament (PCL) injury

First contact (GP or physio)

No good study

Sports medicine
  • 0.65% Sports knee injuries over 10 years. Majewski 2006, n=7769 [hospital orthopaedic series; denominator is knee injuries; abstract source only]
Emergency department
  • 38% (85/222) Acute haemarthrosis, US regional trauma centre. Fanelli 1995, n=222 [haemarthrosis only; 57% of the PCL injuries were in (non-sport) trauma patients; almost all (96.5%) with other ligament injuries; method not stated in abstract; abstract source only]
Specialist or orthopaedic (context)
  • 8.2% (27/331) Haemarthrosis, MRI at referral imaging service. LaPrade 2007, n=331 [haemarthrosis only; abstract source only]
  • 2.7% (3/113) Athletes, haemarthrosis, no clinical laxity. DeHaven 1980, n=113 [surgical series; abstract source only]
  • 44% (27/61) Acute haemarthrosis, tertiary trauma centre. Fanelli 1993, n=61 [surgical series (examination under anaesthetic plus arthroscopy, trauma centre); haemarthrosis only; mostly non-sport trauma patients (81.5% of PCL cases); abstract source only]

Knee fracture after an acute knee injury

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 5.7% (63/1096) Adults with acute knee injury, Ottawa EDs. Stiell 1996, n=1096 [clinically important fractures; 6.5% in Stiell 1995; abstract source only]
  • 7.8% (22/283) Blunt knee injury within 7 days, Tehran. Jalili 2010, n=283 [abstract source only]
  • 9.3% (70/750) Children 2-16 with knee injury, Canada. Bulloch 2003, n=750 [abstract source only]
Specialist or orthopaedic (context)
  • 67% (14/21) Children 10-17, haemarthrosis, arthroscopy. Matelic 1995, n=21 [surgical series; osteochondral fracture; X-ray missed 5; abstract source only]
  • 6% (7/113) Athletes, haemarthrosis, no clinical laxity. DeHaven 1980, n=113 [surgical series; osteochondral fractures; abstract source only]

Kneecap (lateral patellar) dislocation

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 17% Acute knee injury with rapid swelling, Sweden. Olsson 2016, n=1145 [haemarthrosis only; 39% boys and 43% girls aged 16 or under; abstract source only]
Specialist or orthopaedic (context)
  • 11% Haemarthrosis having urgent arthroscopy, Czech. Bilik 2012, n=266 [surgical series; abstract source only]
  • 23% Haemarthrosis having acute arthroscopy, Finland. Sarimo 2002, n=320 [surgical series; abstract source only]

Patellofemoral pain

First contact (GP or physio)
  • 17% (303/1782) Adults consulting GP about the knee, UK. Wood 2011, n=1782 [GP coding; includes some bursitis and kneecap OA; probably under-counted; abstract source only]
  • 11% (89/809) Age 12+, any new knee complaint, GP. van Middelkoop 2008, n=809 [GP working diagnosis; 34% coded only 'knee complaint']
Sports medicine
  • about 25% Athletes at UK sports injury clinic. Devereaux 1984, n=not stated [of knee problems (137 cases); 5.4% of all injuries; abstract source only]
  • 22% Runners' clinic injuries, South Africa. Pinshaw 1984, n=196 [of all running injuries ('runner's knee'); abstract source only]
  • Most common Runners at Vancouver sports medicine centre. Taunton 2002, n=2002 [ranking only; percentage not verified; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Patellar tendinopathy (jumper's knee)

First contact (GP or physio)
  • 9.3% (75/809) Age 12+, any new knee complaint, GP. van Middelkoop 2008, n=809 [GP label 'jumper's knee', not defined; use with caution]
Sports medicine
  • 2.1% Athletes under 50, Japanese sports clinic. Iwamoto 2008, n=2989 [of all athletes seen, not knee only; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Knee osteoarthritis

First contact (GP or physio)
  • 61% (292/480) Over 35, non-injury knee complaint, Dutch GP. Belo 2009, n=480 [ACR clinical criteria; 480 followed of 549; abstract source only]
  • 8.7% (70/809) Age 12+, any new knee complaint, GP. van Middelkoop 2008, n=809 [GP working diagnosis; all ages]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Baker's (popliteal) cyst

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 25.6% (102/399) Non-injury knee pain, rheumatology ultrasound, Italy. Picerno 2014, n=399 [ultrasound finding; abstract prints 25.8%; abstract source only]
  • 37% (72/195) Chronic knee OA pain, Greece. Chatzopoulos 2008, n=195 [ultrasound finding; 27% of knees; abstract source only]

Iliotibial band syndrome

First contact (GP or physio)

No good study

Sports medicine
  • 12% Runners' clinic injuries, South Africa. Pinshaw 1984, n=196 [of all running injuries; abstract source only]
  • 2nd most common Runners at Vancouver sports medicine centre. Taunton 2002, n=2002 [ranking only; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Osgood-Schlatter disease

First contact (GP or physio)
  • 1.0% (8/809) Age 12+, any new knee complaint, GP. van Middelkoop 2008, n=809 [all ages (mean 45), so understates adolescents]
Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Rule It In, Rule It Out shows how to use these starting points with the tests.

Ankle/foot

Ankle fracture after an ankle injury

First contact (GP or physio)
  • 8.5% (8/94) Inversion ankle injury, 3 US family practices. Smith 1993, n=94 [about 90% X-rayed; fracture site not separated; only 1 of the 8 needed treatment different from a sprain; abstract source only]
Sports medicine
  • 8.3% (11/132) Acute ankle injury, university sports medicine. Leddy 1998, n=132 [ankle or midfoot; all X-rayed; abstract source only]
  • 6.7% (7/104) Military cadets with ankle injury. Gerber 1998, n=104 [abstract source only]
Emergency department
  • 11.7% (121/1032) Adults with acute ankle injury, Ottawa EDs. Stiell 1993, n=1032 [malleolar zone fractures; abstract source only]
  • 9.3% (70/750) Adults with acute ankle injury, Ottawa EDs. Stiell 1992, n=750 [malleolar zone fractures; abstract source only]
  • 12% (70/584) Ankle injury, Glasgow ED, patients who were X-rayed (73% of 800). Perry 1999, n=584 [any fracture; 10.8% clinically significant; 8.8% of all 800 is a minimum, because those not X-rayed were not followed up]
Specialist or orthopaedic (context)

No good study

Midfoot fracture after an ankle/foot injury

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 4.7% (49/1032) Adults with acute ankle/foot injury, Ottawa. Stiell 1993, n=1032 [of all patients; abstract source only]
  • 14% (32/230) Adults who had a foot X-ray, Ottawa. Stiell 1992, n=230 [had foot X-ray; 4.3% of all 750; abstract source only]
  • 19.5% (29/149) Foot X-rays, US community hospital ED. Lucchesi 1995, n=149 [n = foot X-rays, not patients; abstract source only]
Specialist or orthopaedic (context)

No good study

Fifth metatarsal fracture

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department
  • 40.5% (34/84) Foot injury, tender 5th metatarsal, Turkey. Yesilaras 2014, n=84 [pre-selected by tenderness; abstract source only]
Specialist or orthopaedic (context)

No good study

Lateral ankle ligament injury

First contact (GP or physio)

No good study

Sports medicine
  • 73% (76/104) Military cadets with ankle injury. Gerber 1998, n=104 [clinical sprain diagnosis, not proven rupture; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 76% (122/160) Consecutive inversion injuries, Amsterdam hospital. van Dijk 1996, n=160 [rupture confirmed at surgery (135 operated, 122 ruptures); non-operated all stable at follow-up; abstract source only]
  • 39.5% (103/261) Athletes referred for MRI after sprain, Qatar. Roemer 2014, n=261 [had MRI; complete ATFL tear without syndesmosis injury; abstract source only]

Syndesmosis (high ankle) sprain

First contact (GP or physio)

No good study

Sports medicine
  • 15.4% (16/104) Military cadets with ankle injury. Gerber 1998, n=104 [clinical plus X-ray; abstract source only]
  • 1.1% (15/1344) Ankle sprains, military academy, 41 months. Hopkinson 1990, n=1344 [chart review; same academy as Gerber; abstract source only]
  • 7% (94/1320) Pro footballers' ankle ligament injuries, UEFA. Lubberts 2019, n=1320 [isolated syndesmosis injuries; team doctors' diagnosis; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 20% (53/261) Athletes referred for MRI after sprain, Qatar. Roemer 2014, n=261 [had MRI; abstract source only]
  • 15% (14/96) Acute sprain, normal X-ray, Hamburg trauma department. Grosterlinden 2016, n=96 [normal X-ray; MRI; abstract source only]

Achilles tendon rupture

First contact (GP or physio)

No good study

Sports medicine
  • 3% Athletes with Achilles complaints, Finnish sports unit. Kvist 1991, n=698 [n = complaints; mixes chronic and acute problems; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Achilles tendon pain: mid-tendon versus insertional

First contact (GP or physio)

No good study

Sports medicine
  • 66% paratenon / 23% insertional Athletes with Achilles complaints, Finnish sports unit. Kvist 1991, n=698 [paper's label is 'paratenonitis (including tendinopathies)'; musculotendinous 8%; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Plantar fasciitis (plantar heel pain)

First contact (GP or physio)
  • 7.5% (339/4500) All GP foot/ankle consultations, 12 UK practices. Menz 2010a, n=4500 [n = consultations; under-counted (205 coded 'heel pain')]
  • 8.9% Foot consultations by people aged 50+. Menz 2010b, n=not stated [linked survey cohort; 82 consultations]
Sports medicine
  • 3rd most common Runners at Vancouver sports medicine centre. Taunton 2002, n=2002 [ranking only; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 53% (133/250) Plantar heel pain, hospital foot clinic, Korea. Yi 2011, n=250 [ultrasound plus tenderness; 62% with fat pad atrophy cases]

Anterior ankle impingement

First contact (GP or physio)

No good study

Sports medicine
  • about 0.14% Pro footballers' injuries, 120 European teams. D'Hooghe 2022, n=25462 [anterior impingement was 38% of 93 impingement injuries; of all injuries; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)
  • 12% bony / 63% synovitis Ligament reconstruction for chronic instability, UK. Odak 2015, n=100 [surgical series; abstract source only]

Osteomyelitis under a diabetic foot ulcer

First contact (GP or physio)

No good study

Sports medicine

No good study

Emergency department

No good study

Specialist or orthopaedic (context)
  • 12% (30/247) Diabetes foot clinic patients with a wound. Lavery 2007, n=247 [bone culture; 20% of those with infection; abstract source only]
  • 66% (50/76) Infected foot ulcers admitted to hospital. Grayson 1995, n=76 [inpatients; abstract source only]
  • 68% (28/41) Diabetic foot ulcers, clinic and hospital. Newman 1991, n=41 [n = ulcers; only 9 of 28 suspected clinically; abstract source only]

Bone stress injury in runners

First contact (GP or physio)

No good study

Sports medicine
  • 20% (132/654) Runners 6-17, injured runners' clinic, Boston. DeJong Lempke 2023, n=654 [tibial bone stress injury only; n = diagnoses; abstract source only]
  • 18.7% women / 3.9% men Injured track and field athletes, Japanese sports clinic. Iwamoto 2008, n=not stated [stress fracture (any site); % of injured track and field athletes seen at one clinic, by sex; abstract source only]
Emergency department

No good study

Specialist or orthopaedic (context)

No good study

Rule It In, Rule It Out shows how to use these starting points with the tests.

Conditions left out and why

  • Cervical myelopathy: the only figure (Gruenberger 2023, 21% cord compression) is imaging-only, from one spine surgeon's patients with unclear selection.
  • Subscapularis tear: only surgical (arthroscopy and cuff repair) series were checked.
  • Lumbar segmental instability: Chatprem 2020 was dropped (volunteers recruited by advertising); the only other figure (Fritz 2005) is a pre-selected group with no stated setting.
  • Upper lumbar disc herniation: surgical series only.
  • Disc herniation among all back pain (not just back plus leg pain): only a narrative estimate (Deyo 1992), not a cohort figure.
  • Morton's neuroma: one tiny selected study (Albano 2021, 3 of 27 feet), not suitable for publication.
  • Tarsal tunnel syndrome: no figure from patients presenting with foot pain.
  • Meralgia paraesthetica: population incidence only.
  • Femoral neck stress fracture in runners: no per-patient figure (Kiuru 2003 counts injuries in military recruits; shown instead as bone stress injury around the hip).
  • Functional leg weakness among back pain or ED presenters: the quoted 3.95% could not be found in the published record.
  • Shoulder pain from the neck by symptom-modification testing (Roldan-Ruiz 2024/2025): setting not stated, so not placed in any column.
  • Cervicogenic headache in headache clinics: Leone 1998 is a critical review; its 7-10% are migraine or tension-type patients who meet one criterion, not people with cervicogenic headache.
  • Osteochondritis dissecans in young athletes (Stracciolini 2014): the figures cover any joint, not the knee alone.

Context notes (not used as figures)

  • Knee osteoarthritis in people not seeking care (Peat 2006, UK, adults 50+ with knee pain in the past year, n=819): 33% had symptomatic X-ray osteoarthritis and 30% met ACR clinical criteria. Community sample, not care-seeking, so not used as a starting figure.
  • Achilles rupture (Maffulli 1998, n=202): a test-accuracy sample of 174 clinically diagnosed ruptures plus 28 suspected but intact tendons. The 86% reflects how the study was assembled, so it is not a starting figure.
  • Distal biceps (Baylor 2023): 28 of 64 had surgery; this is a surgery rate, not the share with a rupture. Not used.
  • Patellofemoral pain in adolescents (Rathleff 2016) and Achilles tendinopathy type in runners (Chen 2024) come from community samples, not people seeking care. Not used.
  • Taunton 2002 percentages could not be verified (full text blocked); only its rankings are shown.

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