Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examination.
Lindsay W Larkins, Russell T Baker, Jayme G Baker
PMID 33543095WHAT IT FOUND
No single ankle special test reliably diagnoses ligament tears.
Sensitivity ranges from 32% to 100% depending on the test and method, and many lack any accuracy data. Diagnosis requires combining test results with patient history and signs, not relying on one maneuver.
Key findings
01The anterior drawer test has variable sensitivity (32% to 80%) and specificity (38% to 74%), with accuracy depending heavily on ankle position and force magnitude.
02For syndesmotic injuries, the squeeze test has high specificity (93.5%) but low sensitivity (30-33%), meaning a positive result is strong evidence of injury but a negative result does not rule it out.
03Many common tests, including the posterior drawer, prone anterior drawer, modified anterior drawer, crossed-leg, stabilization, and heel-thump tests, have no published evidence for their diagnostic accuracy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so it does not provide pooled estimates of accuracy. Many included studies were cadaveric, small, or used varying methods, making direct comparison difficult. Several common tests had no published accuracy data at all. The review only included English-language sources, which may introduce selection bias. The original descriptions of some tests were inconsistent or unclear, affecting how they were evaluated.
The easy way to misread this
Do not assume a negative special test rules out a ligament tear. Many tests have low sensitivity, and some lack any accuracy data. A negative result does not mean the ligament is intact; combine test findings with history and other clinical signs.