Iranian Journal of Orthopedic Surgery

Diagnosis of Syndesmosis Sprain (Comparison between Clinical and Radiographic Examination)

Authors

Seyed Morteza Kazemi, MD
Ali Akbar Esmaeileijah, MD
Ali Akbar Esmaeileijah, MD
Farshad Adib, MD
https://doi.org/10.22034/ijos.2020.121242
Abstract
Background: In spite of common occurrence of ankle sprains, syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed.Methods: In 100 patients the sensitivity and specificity of standard radiography and physical examination were tested against MRI of the ankle for the diagnosis of syndesmosis sprain. The clinical tests included: syndesmosis tenderness, squeeze test, external rotation test, and crossed-leg test.Results: Four patients had syndesmosis sprain. In comparison with MRI, the sensitivity and specificity for standard radiography were 25% and 100%. The values for crossed-leg test they were 100%, 74%, for external rotation test 100%, 62.5%, for squeeze test 75%, 61.5%, and for tenderness of syndesmosis were 100%, 58% respectively.Conclusions: Physical examination has high sensitivity and low specificity for diagnosis of syndesmosis sprain. Crossed-leg test is more accurate than the other tests. AP and mortise views have low sensitivity and high specificity. Clinical evaluation and regular radiographs do not yield an accurate account of tibiofibular syndesmotic injury. MRI is recommended in athletes or those with equivocal findings.

Keywords

Ankle
Sprain
Radiography

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