Diagnostic accuracy of clinical tests for ankle syndesmosis injury.

Autor:	Sman AD; Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia., Hiller CE; Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia., Rae K; Sports Clinic, University of Sydney, Camperdown, New South Wales, Australia., Linklater J; Castlereagh Imaging, St Leonards, New South Wales, Australia., Black DA; Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia., Nicholson LL; Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia., Burns J; Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia., Refshauge KM; Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.
Jazyk:	angličtina
Zdroj:	British journal of sports medicine [Br J Sports Med] 2015 Mar; Vol. 49 (5), pp. 323-9. Date of Electronic Publication: 2013 Nov 19.
DOI:	10.1136/bjsports-2013-092787
Abstrakt:	Objective: Our aim was to investigate the diagnostic accuracy of the clinical presentation of ankle syndesmosis injury and four common clinical diagnostic tests. Design: Cross-sectional diagnostic accuracy study. Setting: 9 clinics in two Australian cities. Participants: 87 participants (78% male) with an ankle sprain injury presenting to participating clinics within 2 weeks of injury were enrolled. Methods: Clinical presentation, dorsiflexion-external rotation stress test, dorsiflexion lunge with compression test, squeeze test and ankle syndesmosis ligament palpation were compared with MRI results (read by a blinded radiologist) as a reference standard. Tests were evaluated using diagnostic accuracy, sensitivity, specificity and likelihood ratios (LRs). A backwards stepwise Cox regression model determined the combined value of the clinical tests. Results: The clinical presentation of an inability to perform a single leg hop had the highest sensitivity (89%) with a negative LR of 0.37 (95% CI 0.13 to 1.03). Specificity was highest for pain out of proportion to the apparent injury (79%) with a positive LR of 3.05(95% CI 1.68 to 5.55). Of the clinical tests, the squeeze test had the highest specificity (88%) with a positive LR of 2.15 (95% CI 0.86 to 5.39). Syndesmosis ligament tenderness (92%) and the dorsiflexion-external rotation stress test (71%) had the highest sensitivity values and negative LR of 0.28 (95% CI 0.09 to 0.89) and 0.46 (95% CI 0.27 to 0.79), respectively. Syndesmosis injury was four times more likely to be present with positive syndesmosis ligament tenderness (OR 4.04, p=0.048) or a positive dorsiflexion/external rotation stress test (OR 3.9, p=0.004). Conclusions: Although no single test is sufficiently accurate for diagnosis, we recommend a combination of sensitive and specific signs, symptoms and tests to confirm ankle syndesmosis involvement. An inability to hop, syndesmosis ligament tenderness and the dorsiflexion-external rotation stress test (sensitive) may be combined with pain out of proportion to injury and the squeeze test (specific). (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
Databáze:	MEDLINE
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