Fulcrum Test
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Definition[edit | edit source]
Fulcrum Test is a clinical test used to diagnose Femoral Shaft Stress Fracture. Stress fractures of the femoral shaft are uncommon and mostly occur at the proximal third of the femur[1]
Clinically Relevant Anatomy[edit | edit source]
The Femur is the longest bone in the body and extends from the hip to the knee.
The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap, forming the knee joint. It serves as a site of origin and insertion for many muscles and ligaments.
For more detailed information on the anatomy of the Femur
Purpose[edit | edit source]
The fulcrum test is used to aid the diagnosis of femoral shaft stress fractures.
If the clinical test is positive during the physical examination, the diagnosis must still be confirmed by a bone scan or a Magnetic Resonance Imaging scan(MRI)[2].
Technique[edit | edit source]
The technique of this test is the fulcrum test as described by Johnson et al. [5]
The patient is seated on the examination table with his lower legs dangling. The examiner places one of his arms under the symptomatic thigh. The palm of the hand is facing up and touching the patient’s leg This arm will serve as a fulcrum. At one side of the fulcrum, the force is created by the patient’s body weight. The patient is sitting, so the force si created by the upper body weight. At the other side of the fulcrum, the force is created by the weight of the lower leg and pressure by the examiner’s hand. The arm is then moved slowly towards the proximal thigh while the examiner applies with his other hand a pressure to the dorsum of the knee. When the arm as fulcrum is located under the stress fracture, the pressure on the dorsum of the knee produces an increased discomfort which is described by the patient as a sharp pain and is usually accompanied by apprehension. These tests are very sensitive and were also used during follow up to determine the eligibility of the patient for transfer to the next phase of the treatment. [1,2,3,5]
Evidence[edit | edit source]
Provide the evidence for this technique here
Clinical Relevance[edit | edit source]
References[edit | edit source]
- ↑ Boden BP, Speer KP. Femoral stress fractures. Clinics in sports medicine. 1997 Apr 1;16(2):307-17.
- ↑ Deutsch AL, Coel MN, Mink JH. Imaging of stress injuries to bone: radiography, scintigraphy, and MR imaging. Clinics in sports medicine. 1997 Apr 1;16(2):275-90.
[1] A Ivkovic, I Bojanic, M Pecina. Stress fractures of the femoral shaft in athletes: a new treatment algorithm. Br J Sports Med 2006;40;518-520 (level B)
[2]John W. O’Kane, MD, Laura Jane Matsen. Mid-third femoral stress fracture with hip pain. JABFP January-February 2001; Vol. 14 No. 1 (level C)
[3]Juha-Petri Ruohola. Fatigue fractures in military conscripts: a study on risk factors, diagnostics and long-term consequences. Department of Orthopaedics and Traumatology, University of Helsinki. March 2007 (level D)
[4]Mark Casterline, MS, ATC; Shawn Osowski, MS, LAT, ATC; Gary Ulrich, DO. Femoral stress fracture. Journal of Athletic training 1996. Volume 31 number 1. (level C)
[5] Johnson A W, Weiss C B, Wheeler D L. Stress fractures of the femoral shaft in athletes: more common than expected. A new clinical test. Am J Sports Med 1994. 22248–256.256 (level C)
