Execution
- 1Position the patient sitting or supine with the ankle relaxed.
- 2Palpate the anterior inferior tibiofibular ligament just above the ankle mortise.
- 3Palpate proximally along the interosseous membrane when symptoms extend up the leg.
- 4Palpate the posterior tibiofibular ligament region if posterior pain is reported.
- 5Map the length and intensity of tenderness and compare with the opposite side.
Positive outcome
Localized tenderness over the AITFL, syndesmosis ligaments, or interosseous membrane is positive. Tenderness extending farther proximally may suggest a more severe injury. Diffuse lateral ankle tenderness alone is not specific for syndesmosis injury.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Sman et al. (2015) | prospective diagnostic study | 92 | NA | NA | NA |
| Sman et al. (2013) | systematic review | NA | NA | NA | NA |
CommentLigament tenderness is sensitive in acute syndesmosis injury but not sufficiently specific to confirm the diagnosis. It is valuable because absence of localized syndesmosis tenderness reduces suspicion, while presence of tenderness guides which stress tests to apply carefully. Do not interpret tenderness alone as instability.
Moderate Clinical Value