Cotton Test / Lateral Stress Test | Syndesmosis Injury Beumer et al. (2002) investigated the diagnostic accuracy of the Cotton test and found a sensitivity of 25% while the specificity was not specified. Therefore, the accuracy of this test is questionable. The logic behind the Cotton test is that lateral translation of the talus can only occur if the tibiofibular ligaments are injured or torn as the 'fork' that is formed between the tibia and fibular can spread more than usual. | Physiotutors