Understanding the External Rotation Stress Test (or Syndesmosis Ligament Test) Assessment
To assess the integrity of the **Distal Tibiofibular Syndesmosis** (the 'high ankle sprain' ligaments, including the AITFL and PITFL).
Watch How It's Done
How do I start?
Patient is sitting with the knee flexed to 90° and the foot hanging freely.
What happens?
The examiner stabilizes the tibia and applies a forceful, passive **external rotation force** to the foot (forefoot and talus) while the ankle is in a neutral position.
In Plain English
What Does a Positive Result Mean?
Reproduction of **pain localized to the distal anterior and/or posterior tibiofibular joint** (the high ankle region).
Helpful Tip:
A positive test strongly suggests a syndesmosis sprain. This test is the rotational component of Kleiger's Test.
Safety First
This guide is to help you understand what happens in a clinic. Do not try to diagnose yourself. If you have severe pain, swelling, or cannot put weight on your leg, please visit an urgent care center or your doctor immediately.
Other ankel Tests
Anterior Drawer of the Ankle
To assess the integrity of the **Anterior Talofibular Ligament (ATFL)**, the most commonly injured ligament in lateral ankle sprains.
Figure of Eight Method of Measuring Ankle Joint Swelling
To quantitatively measure and track **ankle and foot edema (swelling)** volume over time.
Impingement sign ankle (Anterior Ankle Impingement)
To diagnose **Anterior Ankle Impingement Syndrome** (bony or soft tissue impingement at the front of the joint).
Kleiger's Test (External Rotation Test)
To assess the integrity of the **Distal Tibiofibular Syndesmosis** (high ankle sprain) and the **Deltoid Ligament** (medial ankle).