Triple Compression Stress Test

Triple Compression Stress Test is used to elicit stress on posterior tibial nerve at the ankle joint, it’s a special test for tarsal tunnel syndrome.

How do you do the Triple Compression Stress Test?

The clinician positions the patient’s ankle in full plantarflexion and inversion while simultaneously applying direct digital pressure for 30 seconds over posterior tibial nerve behind the medial malleolus.

See Also: Ankle Anatomy

See also: Tarsal Tunnel Syndrome

What does a positive Triple Compression Stress Test mean?

Triple Compression Stress Test is positive if there is a reproduction or intensified clinical symptoms and signs of tarsal tunnel syndrome.

Accuracy

A study on 50 subjects with symptoms suggestive of tarsal tunnel syndrome and 40 healthy controls, founds the sensitivity and specificity was (The reference standard was basic motor nerve conduction for tibial nerve):

• Sensitivity: 86%
• Specificity: 100%

This study concluded that the TCST achieved a simple, fast and very reliable provocative maneuver to increase the sensitivity of TTS diagnosis both clinically and electrophysiologically.

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is a compressive neuropathy of the tibial nerve within the fibroosseous tunnel posterior and inferior to the medial malleolus

Reported causes of tarsal tunnel syndrome include:

1. tenosynovitis,
2. engorged or varicose vessels,
3. synovial or ganglion cysts,
4. pigmented villonodular synovitis,
5. nerve sheath tumors,
6. lipomas,
7. fracture of the sustentaculum tali or medial tubercle of the posterior process of the talus,
8. middle facet tarsal coalition,
9. accessory muscles.

Other Physical examination include:

• Percussion of the entire course of the distal tibial nerve and its branches should be performed.
• Tinel sign, radiating pain or discomfort with continuous deep compression over the nerve, or diminished two-point discrimination may be elicited.
  

References

1. Abouelela AA, Zohiery AK. The triple compression stress test for diagnosis of tarsal tunnel syndrome. Foot (Edinb). 2012 Sep;22(3):146-9. doi: 10.1016/j.foot.2012.02.002. Epub 2012 Mar 8. PMID: 22405941.
2. Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.
3. Millers Review of Orthopaedics -7th Edition Book.