Diagnostic accuracy of clinical tests for ankle syndesmosis injury.

Injury to the ankle syndesmosis accounts for up to 24% of all ankle sprains, and is commonly associated with persistent disability and prolonged recovery. Part of this is possibly due to delayed or missed diagnosis, therefore highlighting the importance of accurate clinical tests to facilitate early detection of ankle syndesmosis injury. The aim of the current study was to investigate the accuracy of four commonly used clinical diagnostic tests to identify a sydnesmosis injury.

87 participants presenting to numerous clinics with an ankle sprain injury were investigated over a two-week period. Clinical presentation, dorsiflexion-external rotation stress test, dorsiflexion lunge with compression test, squeeze test and ankle syndesmosis ligament palpation were all compared to each participant’s MRI findings. An inability to perform a single-leg hop was the clinical presentation that had the highest sensitivity amongst those who had a syndesmosis injury. Of the clinical tests, the squeeze test had the highest specificity, whilst both the dorsiflexion-external rotation stress test and syndesmosis ligament tenderness were the most sensitive.

These results suggest that a combination of clinical tests is likely to yield a more accurate diagnosis of an ankle syndesmosis sprain compared to one single test. Numerous positive findings for the above clinical tests should prompt the referral for further investigations under the suspicion of a syndesmosis injury > From Sman et al., Brit J Sport Med (2013) (Epub ahead of print). All rights reserved to BMJ Journals.

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