Test library › Foot, ankle & calf
Clinical tests for syndesmosis (high ankle) sprain, compared
An injury to the ligaments that hold the lower ends of the two lower-leg bones (tibia and fibula) together just above the ankle. Often from the foot being twisted outwards or forced upwards.
The 4 tests in the library for syndesmosis (high ankle) sprain, side by side, each with the published accuracy figures that exist for it. Click a test for what each result means, any caution, and the source.
| Test | Sensitivity | Specificity | LR+ | LR− | Verdict |
|---|---|---|---|---|---|
| Dorsiflexion–external rotation test (Kleiger's) | 71% | 63% | 1.93 | 0.46 | A weak test on its own |
| Squeeze test (syndesmosis) | 26% | 88% | 2.15 | 0.84 | A weak test on its own |
| Syndesmosis ligament tenderness (palpation) | 92% | 29% | 1.3 | 0.28 | A weak test on its own |
| Unable to perform single-leg hop | 89% | 29% | 1.25 | 0.37 | A weak test on its own |
Reading the table
A high LR+ makes a positive result useful for ruling the condition in; a low LR− makes a negative result useful for ruling it out. A test can be good in one direction and weak in the other, and the figures come from different studies and patient groups, so compare them with care.
No single test is accurate alone; screen with the sensitive findings, confirm with the specific ones, and refer for imaging when suspicion remains.
Tests for the same problem are rarely independent, so a second positive adds much less than its own figure suggests. Do not multiply their figures together. Where a combination has been tested as a cluster or a decision rule, Rule It In, Rule It Out gives that published result.
To turn a figure into a probability for your patient, use the probability calculator.
Get the book for spotting a high ankle sprain, and knowing when the Achilles is torn
This page gives the published figures. Rule It In, Rule It Out adds how to do each test, what counts as positive, how to read the result, and, where studied, whether combining tests helps.
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