SportsAnkle sprain: anterior drawer and talar tilt tests
You test the lateral ankle ligaments with the special tests named by the NATA: the anterior drawer, the most common test for the anterior talofibular ligament, and the inversion talar tilt. When you test matters: before swelling builds up in the joint, or 5 days after the injury rather than 2.
Free to startScenarios
- On the sideline, soon after the injury and before the joint fills with swelling.
- At a follow-up 5 days after the injury, when the tests are more accurate than at 2 days.
The steps
- Perform the anterior drawer test to assess the anterior talofibular ligament.
- Perform the inversion talar tilt test for the lateral ligaments.
- Test soon after the injury, before effusion accumulates in the joint.
- If the swelling is already there, test again 5 days after the injury: the tests are more accurate than at 2 days.
- Stay alert for associated injuries, both near and away from the ankle joint.
- Do not rely on stress radiographs to detect an acute ligament rupture: they are unreliable.
- If a tear of the anterior talofibular or calcaneofibular ligament must be confirmed, MRI is reliable after an acute injury; diagnostic ultrasound is useful but less accurate.
Safety rules that stop the station
- The tests are less accurate once swelling has built up in the joint.
To pass
- Anterior drawer and inversion talar tilt done and read.
- Timing chosen well: before the effusion, or repeated at 5 days.
- Associated injuries looked for.
Official source
National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes (J Athl Train, 2013)
The National Athletic Trainers' Association position statement on ankle sprains (Journal of Athletic Training, 2013), free on PubMed Central: recommendations 3 to 5, 8, 9 and 11 and its literature review.
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