Syndesmosis Squeeze Test

The Syndesmosis Squeeze Test (also known as the fibular compression test or Distal Tibiofibular Compression) is used for evaluation of an injury to the tibiofibular syndesmosis.

The pressure is applied transversely through the leg away from the site of pain.

How do you do a Calf Squeeze Test?

• The patient sits at the edge of the examination table.
• The examiner cups both hands (or with one hand between the thumb and the four other fingers) around the patient’s lower leg, away from the site of pain, and compresses it, attempting to squeeze the tibia and fibula together, gradually adding more pressure if no pain or other symptoms are elicited. Progress toward the injured site until pain is elicited.
• The hands must be placed sufficiently far from the distal syndesmosis, on the upper to middle third of the leg at a point approximately 6–8 inches below the knee.

See Also: Ankle Anatomy

What does a positive Squeeze Test mean?

The test is considered positive if pain is felt in the distal third of the leg may indicating a compromised syndesmosis, if the presence of a tibia and/or fibula fracture, calf contusion, or compartment syndrome has been ruled out.

See Also: Lateral Ankle Sprain

Sensitivity & Specificity

A Comparative Study by Paulo Céesar de César ¹ to determine the sensitivity and specificity of external rotation test and squeeze test for syndesmotic injury secondary to lateral ankle sprain:

• Sensitivity: 30 %
• Specificity: 93.5 %

The sensitivity of the squeeze test and external rotation test was low, suggesting that physical examination often fails to diagnose syndesmotic injury. Conversely, specificity was very high; nearly all patients with a positive test actually had syndesmotic injury. Severity of ankle sprain was not associated with prevalence of syndesmotic injury.

See Also: External Rotation Test

Notes

Avoid applying too much pressure too soon into the test. Pressure should be applied gradually and progressively.

The test is infrequently positive for syndesmosis sprains, even in the presence for syndesmosis sprains of other clinical findings indicative of a syndesmosis sprains. Its usefulness is limited.

When an either/or combination of the external rotation and dorsiflexion-compression tests was considered, subjects with a positive test result took significantly longer to return to playing sports.

Related Anatomy

• The distal tibiofibular joint is classified as a syndesmosis, except for approximately 1 mm of the inferior portion, which is covered in hyaline cartilage.
• The joint consists of a concave tibial surface and a convex or plane surface on the medial distal end of the fibula.
• There is a elongation into the joint by the synovium of the talocrural joint, the fibers of which are oriented inferiorly and laterally.
• The fibula serves as a site for muscular and ligamentous attachment, providing stability for the talus at the talocrural joint.
• The tibia is the second longest bone of the skeleton and is a major weight-bearing bone.
• As at the proximal tibiofibular joint, support for this joint is provided primarily by ligaments.

The joint is stabilized by four ligaments, collectively known as the syndesmotic ligaments, these include:

1. The inferior interosseous ligament,
2. The anterior inferior tibiofibular ligament
3. The posterior inferior tibiofibular ligament,
4. The inferior transverse ligament.

Of these ligaments, the inferior interosseous ligament is the primary stabilizer.

Reference

1. de César PC, Avila EM, de Abreu MR. Comparison of magnetic resonance imaging to physical examination for syndesmotic injury after lateral ankle sprain. Foot Ankle Int. 2011 Dec;32(12):1110-4. doi: 10.3113/FAI.2011.1110. PMID: Pubmed
2. Alonso, A, Khoury, L, and Adams, R: Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther, 27:276, 1998. Pubemd
3. Clinical Tests for the Musculoskeletal System, Third Edition book.
4. Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.