Squeeze test
- Fysiobasen
- Oct 4
- 2 min read
The Squeeze Test, also known as the Fibular Compression Test, is a clinical examination used in combination with other tests to help diagnose conditions such as ankle sprains, syndesmotic injuries (high ankle sprains), and arthritis-related pain. It is particularly valuable when paired with the external rotation stress test (Kleiger’s test) for detecting syndesmotic injuries¹.
Technique
The test is performed by compressing the proximal fibula against the tibia to evaluate the integrity of the bones, interosseous membrane, and syndesmotic ligaments.
Procedure:
The patient lies or sits in a relaxed position.
The examiner places both hands around the proximal lower leg and squeezes the tibia and fibula together.
A positive test is indicated when pain is elicited in the distal ankle or syndesmosis region, suggesting injury or diastasis²³.
Evidence
Reliability: Alonso et al. reported moderate reliability (kappa = 0.50)⁵.
Diagnostic accuracy: According to de César et al., the test has a sensitivity of 30% and specificity of 93.5% for high ankle sprains¹.
Test clusters: Sman et al. recommend combining the Squeeze Test with other maneuvers such as the dorsiflexion–external rotation test to improve diagnostic accuracy for syndesmotic injuries⁶.
Clinical Relevance
Beyond ankle injuries, the Squeeze Test has also been shown to be useful in detecting early arthritis in MCP and MTP joints. Studies demonstrated a sensitivity of 31–33% when correlated with MRI-proven synovitis⁷. This highlights the broader utility of the test for inflammatory and degenerative conditions.
Conclusion
The Squeeze Test is a simple, clinically valuable tool with high specificity for detecting syndesmotic injuries. While its low sensitivity limits its use as a standalone test, it becomes highly effective when integrated with other assessments like the dorsiflexion–external rotation test. Its potential role in early arthritis detection also makes it a versatile addition to musculoskeletal evaluation in both acute and chronic cases.
References:
de César PC, Ávila EM, de Abreu MR. Comparison of magnetic resonance imaging to physical examination for syndesmotic injury after lateral ankle sprain. Foot & ankle international. 2011 Dec;32(12):1110-4.
Birrer RB, Fani-Salek MH, Totten VY et al. Managing ankle injuries in the emergency department. The Journal of Emergency medicine. 1999;17:651-660.
Brosky T, Nyland J, Nitz A et al: The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation, J Orthop Sports Phys Ther 21:197-205, 1995.
Syndesmosis Squeeze Test. Available from:https://www.youtube.com/watch?v=rM9Rk1oucHM&feature=emb_logo&ab_channel=PhysicalTherapyNation
Alonso A,Khoury L, Adams R. Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther. 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.
Wouters F, Niemantsverdriet E, Van der Helm-van Mil A. Ab1258 the value of the squeeze test for detection of subclinical synovitis in patients with arthralgia suspicious for progression to RA.(2020).
