Kleigers test

Kleiger’s Test, also known as the dorsiflexion and external rotation test, is used to diagnose ankle injuries, particularly syndesmotic injuries or sprains of the distal tibiofibular joint¹.

Purpose

The test is performed to identify injuries to the syndesmosis — the ligaments that hold the tibia and fibula together in the lower leg. It is especially useful for evaluating sprains or ruptures in this region¹.

Execution

• Patient position: The patient sits with the knee flexed at 90° and the ankle relaxed

• Examiner position: The examiner sits at ankle level, stabilizing the leg from behind with one hand while holding the foot in a neutral position with the other

• Test procedure: The foot is externally rotated. Nussbaum et al. performed the test with the ankle in full dorsiflexion¹

• Positive test: Pain at the interosseous membrane or medially in the ankle indicates injury. Pain may also radiate up the leg depending on severity

Clinical Relevance

• Kleiger’s test shows an inter-rater reliability of 0.75 (kappa value)⁵, with a sensitivity of 25% and specificity of 84.8% compared with MRI¹

• When the ankle is placed in dorsiflexion, sensitivity increases to 75% and the positive likelihood ratio (LR) is 1.93⁶

• More recent studies report a sensitivity of 71% and specificity of 63%, making the test limited as a stand-alone diagnostic tool⁷

Interpretation of Results

• Positive test: Indicates injury to the syndesmosis or the medial ligament

• Combining Kleiger’s Test with other assessments, such as the Squeeze Test, increases diagnostic accuracy for syndesmotic injuries³

Advantages and Limitations

• Advantages: Simple to perform and requires no special equipment

• Limitations: Low sensitivity when used alone, and variations in execution may affect reliability⁴. For this reason, Kleiger’s Test is best used together with other clinical tests when evaluating suspected syndesmotic injuries²,³,⁷

Sources:

1. 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.

2. 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]

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.