Table 1.

Stress tests for distal tibiofibular syndesmosis sprains.

Stress Test	Description
Cotton17	The talus is translated from medial to lateral in the ankle mortise. The test result is positive if there is excessive motion (compared to that of the opposite side) or pain.
Crossed leg35	The patient sits with the middle of the injured leg across the top of the opposite knee. Pressure is applied to the medial aspect of the proximal tibia and fibula at or near the knee to apply shear strain to the distal syndesmosis ligaments. The test result is positive if there is pain at the distal tibiofibular joint. This is essentially a functional squeeze test performed by the patient.
External rotation12	The patient sits over the side of a examination table with the knee in approximately 90° of flexion. The examiner stabilizes the leg midway of the tibial shaft and applies an external rotation moment at the ankle. The test result is positive if there is pain in the region of the distal syndesmosis ligaments or interosseous membrane.
Fibular translation48	The fibula is translated in an anteroposterior direction. The test result is positive with pain in the region of the distal tibiofibular syndesmosis.
Squeeze28	The tibia and fibula are compressed midway up the leg to apply shear strain to the distal syndesmosis ligaments. The test result is positive if there is pain at the distal tibiofibular joint.