{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:46:23Z","timestamp":1790858783535,"version":"4.1.0"},"reference-count":47,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2013,10,19]]},"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Our aim was to investigate the diagnostic accuracy of the clinical presentation of ankle syndesmosis injury and four common clinical diagnostic tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross-sectional diagnostic accuracy study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>9 clinics in two Australian cities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>87 participants (78% male) with an ankle sprain injury presenting to participating clinics within 2\u2005weeks of injury were enrolled.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical presentation, dorsiflexion-external rotation stress test, dorsiflexion lunge with compression test, squeeze test and ankle syndesmosis ligament palpation were compared with MRI results (read by a blinded radiologist) as a reference standard. Tests were evaluated using diagnostic accuracy, sensitivity, specificity and likelihood ratios (LRs). A backwards stepwise Cox regression model determined the combined value of the clinical tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The clinical presentation of an inability to perform a single leg hop had the highest sensitivity (89%) with a negative LR of 0.37 (95% CI 0.13 to 1.03). Specificity was highest for pain out of proportion to the apparent injury (79%) with a positive LR of 3.05(95% CI 1.68 to 5.55). Of the clinical tests, the squeeze test had the highest specificity (88%) with a positive LR of 2.15 (95% CI 0.86 to 5.39). Syndesmosis ligament tenderness (92%) and the dorsiflexion-external rotation stress test (71%) had the highest sensitivity values and negative LR of 0.28 (95% CI 0.09 to 0.89) and 0.46 (95% CI 0.27 to 0.79), respectively. Syndesmosis injury was four times more likely to be present with positive syndesmosis ligament tenderness (OR 4.04, p=0.048) or a positive dorsiflexion\/external rotation stress test (OR 3.9, p=0.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although no single test is sufficiently accurate for diagnosis, we recommend a combination of sensitive and specific signs, symptoms and tests to confirm ankle syndesmosis involvement. An inability to hop, syndesmosis ligament tenderness and the dorsiflexion-external rotation stress test (sensitive) may be combined with pain out of proportion to injury and the squeeze test (specific).<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2013-092787","type":"journal-article","created":{"date-parts":[[2013,11,20]],"date-time":"2013-11-20T03:31:38Z","timestamp":1384918298000},"page":"323-329","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":93,"title":["Diagnostic accuracy of clinical tests for ankle syndesmosis injury"],"prefix":"10.1136","volume":"49","author":[{"given":"Amy D","family":"Sman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire E","family":"Hiller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Rae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Linklater","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah A","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie L","family":"Nicholson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Burns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn M","family":"Refshauge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,11,19]]},"reference":[{"key":"2024051404401113000_49.5.323.1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.1995.21.4.197"},{"key":"2024051404401113000_49.5.323.2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1080\/00913847.1993.11947610","article-title":"Syndesmosis ankle sprains: diagnosing the injury and aiding recovery","volume":"21","author":"Taylor","year":"1993","journal-title":"Phys Sports Med"},{"key":"2024051404401113000_49.5.323.3","doi-asserted-by":"crossref","unstructured":"Kjaer M Krogsgaard M Magnusson P . 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