The patient sits at the edge of the examination table.
The examiner cups both hands (or with one hand between the thumb and the four other fingers) around the patient’s lower leg and compresses it, attempting to squeeze the tibia and fibula together.
The hands must be placed sufficiently far from the distal syndesmosis, on the upper to middle third of the leg at a point approximately 6–8 inches below the knee.
What does a positive Squeeze Test mean?
The test is considered positive if pain is felt in the distal third of the leg may indicating a compromised syndesmosis, if the presence of a tibia and/or fibula fracture, calf contusion, or compartment syndrome has been ruled out.
Sensitivity & Specificity
A Comparative Study by Paulo Céesar de César1 to determine the sensitivity and specificity of external rotation test and squeeze test for syndesmotic injury secondary to lateral ankle sprain:
Sensitivity: 30 %
Specificity: 93.5 %
The distal tibiofibular joint is classified as a syndesmosis, except for approximately 1 mm of the inferior portion, which is covered in hyaline cartilage.
The joint consists of a concave tibial surface and a convex or plane surface on the medial distal end of the fibula.
There is a elongation into the joint by the synovium of the talocrural joint, the fibers of which are oriented inferiorly and laterally.
The fibula serves as a site for muscular and ligamentous attachment, providing stability for the talus at the talocrural joint.
The tibia is the second longest bone of the skeleton and is a major weight-bearing bone.
As at the proximal tibiofibular joint, support for this joint is provided primarily by ligaments.
The joint is stabilized by four ligaments, collectively known as the syndesmotic ligaments, these include:
The inferior interosseous ligament,
The anterior inferior tibiofibular ligament
The posterior inferior tibiofibular ligament,
The inferior transverse ligament.
Of these ligaments, the inferior interosseous ligament is the primary stabilizer.
de César PC, Avila EM, de Abreu MR. Comparison of magnetic resonance imaging to physical examination for syndesmotic injury after lateral ankle sprain. Foot Ankle Int. 2011 Dec;32(12):1110-4. doi: 10.3113/FAI.2011.1110. PMID: 22381194.
Clinical Tests for the Musculoskeletal System, Third Edition book.
Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.