Ligamentous Instability Tests

Ligamentous Stress Tests:

Note: Recent evidence has shown ligamentous stress tests determine that a ligament is sprained but they are unable to differentiate which ligament is sprained. The special tests I have listed have not taken this into account and therefore may be more beneficial as screening for a sprain vs. diagnosing a specific ligament.

Fujii T, Luo Z, Kitaoka HB, et al. The manual stress test may not be sufficient to differentiate ankle ligament injuries. Clinical Biomechanics. Volume 15, Issue 8, October 2000, Pages 619-23.

1. Anterior Drawer: Assesses ATFL integrity.  Patient should be sitting with the knee flexed in a relaxed manner. The examiner grasps the patients heel and translates forward while stabilizing the anterior aspect of the distal tibia.  The ankle should be in relatively 10 degrees of plantarflexion.

2. Talar Tilt: Assesses CFL integrity.  Patient should be sitting, supine or sidelying with knee relaxed and examiner holds the heel stable while inverting the heel with respect to the tibia.  More than 10 degrees difference side-to-side is considered positive.

High Ankle Sprain/Syndesmotic Sprain Tests:

1. Cross-Leg Test: Patient is sitting and crosses the affected leg over the opposite knee. Pressure is then applied to the proximal fibula of the affected leg.  A positive test is pain in the distal ankle.


2. External Rotation Stress Test: Assesses the deltoid ligament. Patient can be sitting or prone. The tester passively internally rotates the tibia, dorsiflexes the ankle and then externally rotates the foot.  A positive test is symptom reproduction.


3. Squeeze Test: Patient is prone and the examiner squeezes the proximal tibia and fibular together.  A positive test is symptom reproduction.


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  • A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports and physical fitness activities. It can also happen when you simply step on an uneven surface, or step down at an angle. –
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    Neville Mccrane February 19, 2013 3:39 am Reply

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