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 patient is seated on the examination table with his lower legs dangling. The examiner places one of his arms under the symptomatic thigh. The examiner’s arm is used as a fulcrum under the thigh and is moved from distal to proximal thigh as gentle pressure is applied to the dorsum of the knee with the opposite hand. At the point of the fulcrum under the stress fracture, gentle pressure on the knee produced increased discomfort that was often described as sharp pain and accompanied by apprehension. The contralateral leg served as a negative control. The level at which the fulcrum test is positive has always corresponded to the site of the stress fracture in the femoral shaft as seen in a scintigram or radiograph. [3]
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.
- ↑ Johnson AW, Weiss Jr CB, Wheeler DL. Stress fractures of the femoral shaft in athletes—more common than expected: a new clinical test. The American Journal of Sports Medicine. 1994 Mar;22(2):248-56.
[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)
