[RESEARCH] Accuracy of High Ankle Sprain Tests

Accuracy of High Ankle Sprain Tests

INTRO:

A high ankle sprain involves injury to the distal tibiofibular syndesmosis, a fibrous joint stabilized by four ligaments:

AITFL, IOL, PITFL, TTFL.

Syndesmotic injuries take 2x as long vs. a low ankle sprain to return to sport. Inaccurate or delayed diagnosis can lead to repeated episodes of ankle instability, predisposing to early degenerative changes, and post-traumatic OA. Diagnosis should quantify the degree of instability, as unstable injuries are prioritized for surgery vs. conservative treatment. Arthroscopy, MRI, & diagnostic ultrasound provide high sensitivity and specificity, however, access may be limited.

Physical examination remains a central tenet for diagnosis, including:

Squeeze test
External rotation test
Cotton test
Crossed-leg test
Heel-thump test
Palpation

This systematic review determined the diagnostic accuracy of clinical tests and proposed an algorithm for optimizing test clustering.

RESULTS:

6 studies
512 participants
13 clinical tests

No individual test was associated with both high sensitivity and high specificity.

Tests with the highest sensitivity:

Palpation 92%
Dorsiflexion lunge 75%

Tests with the highest specificity:

Squeeze test 85%
External rotation 78%

CONCLUSIONS:

No individual test can both rule in and rule out injury of the ankle syndesmosis accurately.

Optimal diagnostic approach:

Initial clustering of tests with high sensitivity (palpation; dorsiflexion lunge)
Followed by a test with high specificity (squeeze)

These tests cannot definitively diagnose stable vs unstable.

Decisions on conservative vs surgical management require additional imaging or arthroscopy.

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SOURCE:

Netterstr€om-Wedin, 2021. Diagnostic accuracy of clinical tests assessing ligamentous injury ofthe ankle syndesmosis: PT in Sport, (49), pp. 214-226.

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.

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