Ankle & Foot
Syndesmosis (High Ankle Sprain)
Evidence: confirmed
External Rotation Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing syndesmosis injuries (High Ankle Sprain).
How to Perform
- Position: Patient sits with the knee bent at 90°.
- Action: Hold the foot and rotate it outwards (laterally) while keeping the ankle locked in a neutral position.
Interpretation of Results
- Positive Test: Pain is reproduced over the syndesmosis (between the tibia and fibula).
Diagnostic Accuracy
- Sensitivity: 20 %
- Specificity: 84 %
Clinical Context & Limitations
The External Rotation Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the External Rotation Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
