Dorsiflexion External Rotation Stress Test | Syndesmosis Injury

In this video I’m going to show you the dorsiflexion external rotation stress test to diagnose syndesmosis injuries Hi, and Welcome back to Physiotutors Early and accurate diagnosis of ankle syndesmosis injury is essential to facilitate timely effective and safe treatment But they are difficult to diagnose the incidence in ankle sprains ranges between 1 and 24 percent The ankle syndesmosis includes the interosseous membrane and interosseous ligament together with the anterior inferior tibiofibular ligament posterior inferior tibiofibular ligament and transverse ligament A recent systematic review showed that the external rotation stress test as used by Boytim et al. from the year 2002 had very low of all diagnostic accuracy and lower sensitivity however the test was performed without dorsiflexion Dorsiflexion produces a slight widening of the anchor modus there by stressing the syndesmosis and should therefore be integral to test performance the dorsiflexion external rotation stress test reproduces the mechanism of injury to the syndesmosis According to a study by Sman et al. in the year 2013 it has a sensitivity of 71 percent and a specificity of 63 percent and its clinical use as stand-alone test is therefore rather weak To perform the test have your patient in sitting position with this knee hanging from the table in 90 degrees Then bring the patient’s talocrural joint into maximum dorsiflexion and apply an external rotation stress to the injured foot and ankle This test is positive if the patient’s anterior lateral pain over the syndesmosis is reproduced Alright, this was our video on the external rotation stress test, if you are curious about a more specific test for syndesmosis Injuries watch our video on the squeeze tests right next to me if you like this video, please click on the like button and subscribe to our channel if you haven’t and support our channel if you like our content, you can find various options in the description down below This was Kai for Physio tutors. Thanks a lot for watching bye

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  1. Thanks for this video. It's the best I've found. May you explain the difference between syndesmosis & interosseous membrane? They seem the same to me.

  2. Thank you Physiotutors for your videos, they are amazing and providing me with a degree haha I have some questions regarding syndesmosis testing. In one of your older videos which can be found on physiopedia:

    One Test you suggest is the external rotation stress test where you describe a specificity of 99% and a sensitivity of 20%. Then you have the dorsiflexion external rotation stress test which has a sens: 71% and specificity of 54%. Firstly, I cannot find your video anymore other than on physiopedia with the external rotation stress test (without dorsiflexion). Secondly, which test would you perform? The test without dorsiflexion has a higher specificity which would make it a good test to confirm your hypothesis if signs and symptoms are included. However, the test with added dorsiflexion seems closer to imitating the mechanism of injury in a syndesmosis sprain. Also it is weird that these two tests have very different sens and spec findings as they are very close.

    Small bracket: which test would you perform (other than the talar tilt with neutral position and eversion ) to test for deltoid ligament ruptures?

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