Kleiger's Test
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Purpose
Kleiger's test also known as dorsiflexion external rotation stress test is one of the clinical tests used to diagnose ankle injuries. It helps to specifically identify a syndesmosis injury or distal tibiofibular sprain. [1].
Technique
Patient position: in a seated position, with knee hanging in 90 degrees, ankle relaxed.
Examiner: sitting at the level of the ankle to be tested with one hand stabilizing the leg from behind, the other hand grasp the ankle in neutral position then externally rotation of the foot. Nussbaum et al performed the test with the ankle fully dorsiflexed[1].
Test positive: if there is pain at the site of the interosseous membrane, or medially. Pain may radiate upward to the leg depending on the severity of the injury.
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The squeeze test also known as the fibular compression test has recently been identified to be used in combination with other tests to determine the diagnosis of medical conditions like ankle sprains, arthritis and other medical conditions
Evidence
A combination of tests, signs and symptoms are needed to specifically diagnose ankle syndesmosis injury. Signs like not being able to hop, tenderness of the syndesmosis ligament, severe pain medially in addition to the dorsiflexion-external rotation stress test (Kleigers test) are used for the diagnosis. [3]
The clinical diagnosis has low accuracy and sensitivity because Kleigers test mimicks the mechanism of injury to the syndesmosis. [4]
Interrater reliability 0.75 according to kappa[5]. and a sensitivity of 25% and specificity of 84.8% when comparing the test with MRI finding[1].
With ankle dorsiflexion, the sensitivity of 75%, and the positive LR = 1.93[6].
A sensitivity of 71% and a specificity of 63% has been recently reported confirming its clinical use as a stand-alone test weak. [7]
References
- ↑ 1.0 1.1 1.2 Larkins L, Baker R, Baker J. Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examination. Archives of Rehabilitation Research and Clinical Translation. 2020 Jul 8:100072.
- ↑ Ortho EVAL Pal With Paul Marquis. Kleiger's test for High Ankle Sprain/Special Test for the Ankle. Available from: http://www.youtube.com/watch?v=AXPxMmChQj0[last accessed 26/2/2020]
- ↑ Sman AD, Hiller CE, Rae K, Linklater J, Black DA, Nicholson LL, Burns J, Refshauge KM. Diagnostic accuracy of clinical tests for ankle syndesmosis injury. British journal of sports medicine. 2015 Mar 1;49(5):323-9.
- ↑ Beumer A, Swierstra BA, Mulder PG. Clinical diagnosis of syndesmotic ankle instability: evaluation of stress tests behind the curtains. Acta Orthopaedica Scandinavica. 2002 Dec 1;73(6):667-9.
- ↑ Alonso A, Khoury L, Adams R. Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. Journal of Orthopaedic & Sports Physical Therapy. 1998 Apr;27(4):276-84.
- ↑ Sman AD, Hiller CE, Rae K, Linklater J, Black DA, Nicholson LL, Burns J, Refshauge KM. Diagnostic accuracy of clinical tests for ankle syndesmosis injury. British journal of sports medicine. 2015 Mar 1;49(5):323-9.
- ↑ Sman AD, Hiller CE, Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. British journal of sports medicine. 2013 Jul 1;47(10):620-8.