Accuracy of High Ankle Sprain Tests
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:
External rotation test.
This systematic review determined the diagnostic accuracy of clinical tests and proposed an algorithm for optimizing test clustering.
13 clinical tests
No individual test was associated with both high sensitivity and high specificity.
Tests with the highest sensitivity:
Dorsiflexion lunge 75%
Tests with the highest specificity:
Squeeze test 85%
External rotation 78%
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.
Netterstr€om-Wedin, 2021. Diagnostic accuracy of clinical tests assessing ligamentous injury ofthe ankle syndesmosis: PT in Sport, (49), pp. 214-226.
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