Aims: To study the feasibility of clinical tests in the diagnosis of syndesmotic injury of the ankle. Methods: 9 investigators examined 12 persons twice, including 2 patients with an arthroscopically-conþrmed syndesmotic injury. The persons were sitting behind a curtain that exposed only the lower legs. Results: There was a signiþcant relation between the þnal arthroscopic diagnosis and the squeeze test, þbula translation test, Cotton test, and external rotation test, as well as limited dorsal ßexion. None of the syndesmotic tests was uniformly positive in chronic syndesmotic injury. The external rotation test had the fewest false-positive results, the þbula translation test the most. The external rotation test had the smallest inter-observer variance. The physical diagnosis was missed in about one þfth of all examinations. Conclusions: When in accordance with medical history and physical examination, positive stress tests should raise a high index of suspicion of syndesmotic injury. The þnal diagnosis of syndesmotic instability, however, should be made by additional diagnostic imaging and/or arthroscopy.