Anterior Drawer of the Ankle: Difference between revisions
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'''Original Editor '''- [[User:Staci Burns|Staci Burns]] | '''Original Editor ''' - [[User:Staci Burns|Staci Burns]] | ||
'''Lead Editors''' - [[User:Peter Vaes|Peter Vaes]]. | '''Lead Editors''' - [[User:Peter Vaes|Peter Vaes]]. If you would like to be added as a lead editor on this page please [[Physiopedia:Editors|read more.]] | ||
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== Purpose | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
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== Purpose == | |||
[[Image:Interactive foot - ankle and foot - L10F26.jpg|thumb|left|Courtesy of Primal Pictures]] The purpose of this test was to determine whether ankle mechanical instability or hypermobility in the sagital plane of the talo-crural joint (or upper ankle joint) is present. | [[Image:Interactive foot - ankle and foot - L10F26.jpg|thumb|left|Courtesy of Primal Pictures]] The purpose of this test was to determine whether ankle mechanical instability or hypermobility in the sagital plane of the talo-crural joint (or upper ankle joint) is present.<br> | ||
== Technique | == Technique == | ||
{| class="FCK__ShowTableBorders" cellspacing="1" cellpadding="1" border="0" align="right" width="40%" | {| class="FCK__ShowTableBorders" cellspacing="1" cellpadding="1" border="0" align="right" width="40%" | ||
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The patient is supine, the knee joint is in 20° of flexion, the heel is resting on the palm of the examiner's hand that is resting on the table thereby stabilizing the calcaneus. The examiner pushes the tibia (and fibula) posteriorly observing the amount of posterior translation of the [[Tibia|tibia]] and fibula at the lateral aspect of the ankle and the change in endfeel. The amount of posterior translation and the eventual weakening of the endfeel, changing from hard ligamentous to weak elastic, is observed. A posterior translation greater than 1 cm compared to the healthy contralateral ankle and an evident weakening of the endfeel are most indicative of a partial rupture or complete rupture of the anterior talofibular ligament. The test is graded on a 4-point scale. 0 represents no laxity and 3 represents gross laxity.<br> | The patient is supine, the knee joint is in 20° of flexion, the heel is resting on the palm of the examiner's hand that is resting on the table thereby stabilizing the calcaneus. The examiner pushes the tibia (and fibula) posteriorly observing the amount of posterior translation of the [[Tibia|tibia]] and fibula at the lateral aspect of the ankle and the change in endfeel. The amount of posterior translation and the eventual weakening of the endfeel, changing from hard ligamentous to weak elastic, is observed. A posterior translation greater than 1 cm compared to the healthy contralateral ankle and an evident weakening of the endfeel are most indicative of a partial rupture or complete rupture of the anterior talofibular ligament. The test is graded on a 4-point scale. 0 represents no laxity and 3 represents gross laxity.<br><br> | ||
== Evidence == | == Evidence == | ||
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Anterior drawer has [[Test Diagnostics|sensitivity]] of 86 percent and [[Test Diagnostics|specificity]] of 74 percent for a diagnostic test of 160 patients with an inversion ankle sprain when compared to an arthrogram. The +LR .22 and -LR .0018 (is this from Van Dijk?). | Anterior drawer has [[Test Diagnostics|sensitivity]] of 86 percent and [[Test Diagnostics|specificity]] of 74 percent for a diagnostic test of 160 patients with an inversion ankle sprain when compared to an arthrogram. The +LR .22 and -LR .0018 (is this from Van Dijk?). | ||
In a prospective, blinded, diagnostic-accuracy study Croy et al. measured diagnostic accuracy of the anterior drawer test of the ankle in sixty-six subjects with a history of lateral ankle sprain. Using ultrasound imaging during performance of the the anterior drawer test the talofibular interval was measured digitally.<br> | In a prospective, blinded, diagnostic-accuracy study Croy et al. measured diagnostic accuracy of the anterior drawer test of the ankle in sixty-six subjects with a history of lateral ankle sprain. Using ultrasound imaging during performance of the the anterior drawer test the talofibular interval was measured digitally.<br> | ||
Sensitivity of the the anterior drawer test was 0.74 (95% confidence interval [CI]: 0.58, 0.86) and 0.83 (95% CI: 0.64, 0.93) at the 2.3 mm or greater and 3.7 mm or greater reference standards, respectively. Specificity of the test was 0.38 (95% CI: 0.24, 0.56) and 0.40 (95% CI: 0.27, 0.56), respectively. Positive likelihood ratios were 1.2 and 1.4, whereas the negative likelihood ratios were 0.66 and 0.41, respectively (Croy et al., 2013)(Evidence level 2B). | Sensitivity of the the anterior drawer test was 0.74 (95% confidence interval [CI]: 0.58, 0.86) and 0.83 (95% CI: 0.64, 0.93) at the 2.3 mm or greater and 3.7 mm or greater reference standards, respectively. Specificity of the test was 0.38 (95% CI: 0.24, 0.56) and 0.40 (95% CI: 0.27, 0.56), respectively. Positive likelihood ratios were 1.2 and 1.4, whereas the negative likelihood ratios were 0.66 and 0.41, respectively (Croy et al., 2013)(Evidence level 2B).<br> | ||
== Resources == | == Resources == | ||
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References will automatically be added here, see [[Adding References|adding references tutorial]]. | References will automatically be added here, see [[Adding References|adding references tutorial]]. | ||
Croy T, Koppenhaver S, Saliba S, Hertel J. Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle. J Orthop Sports Phys Ther. 2013;43(12):911-9. <br> | Croy T, Koppenhaver S, Saliba S, Hertel J. Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle. J Orthop Sports Phys Ther. 2013;43(12):911-9. <br> | ||
van Dijk C, et al. Physical Examination is sufficient for the diagnosis of sprained ankles. ''J Bone Joint Surg.'' 1996;78-B:958-962. | van Dijk C, et al. Physical Examination is sufficient for the diagnosis of sprained ankles. ''J Bone Joint Surg.'' 1996;78-B:958-962. | ||
<br> | <br> | ||
<br> <references /> | <br> <references /> | ||
[[Category:Videos]] [[Category:Ankle]] [[Category:EIM_Residency_Project]] [[Category:Special_Tests]] [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] [[Category:Assessment]] | [[Category:Videos]] [[Category:Ankle]] [[Category:EIM_Residency_Project]] [[Category:Special_Tests]] [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] [[Category:Assessment]] | ||
Revision as of 18:39, 10 March 2017
Original Editor - Staci Burns
Lead Editors - Peter Vaes. If you would like to be added as a lead editor on this page please read more.
Top Contributors - Admin, Jennifer Chew, Evan Thomas, Kim Jackson, Rachael Lowe, Peter Vaes, Laura Ritchie, Tony Lowe, Staci Burns, Kai A. Sigel, WikiSysop, Wanda van Niekerk, Dan Rhon, Bram Van Steenbergen, Vidya Acharya and Claire Knott
Purpose[edit | edit source]
The purpose of this test was to determine whether ankle mechanical instability or hypermobility in the sagital plane of the talo-crural joint (or upper ankle joint) is present.
Technique[edit | edit source]
| [1] |
The patient is supine, the knee joint is in 20° of flexion, the heel is resting on the palm of the examiner's hand that is resting on the table thereby stabilizing the calcaneus. The examiner pushes the tibia (and fibula) posteriorly observing the amount of posterior translation of the tibia and fibula at the lateral aspect of the ankle and the change in endfeel. The amount of posterior translation and the eventual weakening of the endfeel, changing from hard ligamentous to weak elastic, is observed. A posterior translation greater than 1 cm compared to the healthy contralateral ankle and an evident weakening of the endfeel are most indicative of a partial rupture or complete rupture of the anterior talofibular ligament. The test is graded on a 4-point scale. 0 represents no laxity and 3 represents gross laxity.
Evidence[edit | edit source]
Anterior drawer has sensitivity of 86 percent and specificity of 74 percent for a diagnostic test of 160 patients with an inversion ankle sprain when compared to an arthrogram. The +LR .22 and -LR .0018 (is this from Van Dijk?).
In a prospective, blinded, diagnostic-accuracy study Croy et al. measured diagnostic accuracy of the anterior drawer test of the ankle in sixty-six subjects with a history of lateral ankle sprain. Using ultrasound imaging during performance of the the anterior drawer test the talofibular interval was measured digitally.
Sensitivity of the the anterior drawer test was 0.74 (95% confidence interval [CI]: 0.58, 0.86) and 0.83 (95% CI: 0.64, 0.93) at the 2.3 mm or greater and 3.7 mm or greater reference standards, respectively. Specificity of the test was 0.38 (95% CI: 0.24, 0.56) and 0.40 (95% CI: 0.27, 0.56), respectively. Positive likelihood ratios were 1.2 and 1.4, whereas the negative likelihood ratios were 0.66 and 0.41, respectively (Croy et al., 2013)(Evidence level 2B).
Resources[edit | edit source]
add any relevant resources here
Recent Related Research (from Pubmed)[edit | edit source]
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References
[edit | edit source]
References will automatically be added here, see adding references tutorial.
Croy T, Koppenhaver S, Saliba S, Hertel J. Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle. J Orthop Sports Phys Ther. 2013;43(12):911-9.
van Dijk C, et al. Physical Examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg. 1996;78-B:958-962.
- ↑ Physiotutors. http://www.youtube.com/watch?v=qoWaHa3M1nw; Accessed Feb 2017
