Fibular Translation Test

What are syndesmosis injuries?

Syndesmosis injuries, also known as high ankle sprain, affect the distal tibiofibular ligaments and typically arise from sudden external rotation of the ankle (Karadsheh, 2019). These injuries are not as common as typical ankle sprains but can cause significant discomfort and impairment. External rotation forces during injury cause the talus to rotate laterally, pushing the fibula away from the tibia. This can lead to increased stresses on the tibia, likelihood of lateral subluxation of the distal fibula, and incongruence of the ankle joint articulation.

Symptoms of syndesmosis injuries include anterolateral ankle pain proximal to the anterior inferior tibiofibular ligament, accompanied by tenderness and swelling (Karadsheh, 2019). Patients may struggle to bear weight, particularly when the interosseous membrane is involved. Diagnosis relies on clinical suspicion, palpation for tenderness over the syndesmosis, and specific provocative tests like the squeeze and external rotation stress tests.

Imaging, such as radiographs and MRI, aids in confirming the diagnosis, especially when syndesmotic injuries are suspected with normal radiographs. Treatment varies depending on the severity of the injury. Nonoperative approaches involve immobilization with a CAM boot or cast and a physical therapy program. Operative management, including syndesmosis screw fixation or suture button fixation, is indicated for more severe cases with instability or associated fractures.

How to diagnose syndesmosis injuries

Diagnosing syndesmosis injuries involves a comprehensive assessment, including history, observation, palpation, and special testing. Clinical history, particularly focusing on mechanisms of injury, such as external rotation, is crucial. Observation may reveal less swelling than lateral ankle sprains and limitations in plantar flexion and weight-bearing ability. Palpation over specific areas, including the anterior tibiofibular ligament and the interosseous membrane, aids in identifying tenderness.

Special tests like the Fibular Translation Test assess for increased translation, indicative of syndesmosis instability. Imaging, including plain films and MRI, confirms the diagnosis and guides treatment decisions (Physiopedia, n.d.).

What is the Fibular Translation Test?

The Fibular Translation Test is a valuable assessment tool for identifying syndesmosis injuries following ankle trauma. It involves gently translating the fibula anteriorly and posteriorly while stabilizing the tibia, typically performed with the patient in a side-lying position. This test assesses the integrity of the syndesmosis, which is a group of ligaments that connect the tibia and fibula bones in the lower leg.

Research by Beumer et al. (2011) demonstrates its sensitivity of 75% and specificity of 88% in diagnosing such injuries. A positive test is indicated by pain during translation or increased movement compared to the unaffected side. This test aids clinicians in accurately diagnosing syndesmosis injuries and guiding appropriate treatment strategies for optimal patient outcomes (Physiotutors, n.d.).

Fibular Translation Test example (sample)

Our Fibular Translation Test PDF is a structured tool for healthcare practitioners to assess potential syndesmosis injuries in patients. It begins with patient information entry, followed by gathering clinical history. The template then guides practitioners through the step-by-step process of performing the Fibular Translation Test accurately. Results interpretation helps in diagnosing and formulating a treatment plan. Finally, documentation and follow-up scheduling ensure comprehensive patient care. This user-friendly template streamlines the assessment process, aiding practitioners in providing efficient and effective care for ankle injuries.

Download this free Fibular Translation Test example here

Results and interpretation of the Fibular Translation Test

As mentioned, a positive Fibular Translation Test indicates a syndesmosis injury, which can range from a mild sprain to a complete rupture of the ligaments. Meanwhile, a negative test suggests the stability of the syndesmosis. However, it is important to note that a negative test does not exclude the possibility of other associated injuries, such as lateral ankle ligament sprains or fractures.

Clinicians should the results of this test carefully, considering both the patient's symptoms and their objective findings. A false negative result may occur if there is significant swelling or guarding by the patient during the assessment, while a false positive result may be seen in patients with chronic ankle instability or previous syndesmosis injuries that have already healed.

Why use Carepatron as your physical therapy software?

Carepatron is a top-tier physical therapy software that offers a user-friendly platform for conducting assessments, including the fibula translation test, a crucial diagnostic tool for syndesmosis sprains. Its intuitive interfaces and customizable templates enable therapists to document clinical findings, enhancing patient care and communication among healthcare teams.

Carepatron also offers advanced administrative functionalities, such as billing and scheduling tools, streamlining practice management and maximizing efficiency. This allows therapists to focus on patient care, fostering stronger patient-provider relationships and driving practice growth.

Carepatron is the ideal choice for physical therapy software, empowering therapists to deliver high-quality care, optimize clinical workflows, and achieve superior patient outcomes.

References:

Beumer, A., Swierstra, B. A., & Mulder, P. G. (2002). Clinical diagnosis of syndesmotic ankle instability: evaluation of stress tests behind the curtains. Acta Orthopaedica Scandinavica, 73(6), 667-669.ISO 690

Karadsheh, M. (2019). High Ankle Sprain & Syndesmosis Injury - Foot & Ankle - Orthobullets. Orthobullets.com. https://www.orthobullets.com/foot-and-ankle/7029/high-ankle-sprain-and-syndesmosis-injury

Physiopedia. (n.d.). Syndesmotic ankle sprains. https://www.physio-pedia.com/index.php?title=Syndesmotic_Ankle_Sprains&oldid=311592Physiotutors. (n.d.).

Physiotutors. (n.d.). Fibular translation test | syndesmosis injury | ankle assessment. https://www.physiotutors.com/wiki/fibular-translation-test/