Fulcrum Test

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Purpose

A stress fracture is a partial or a complete fracture that is a result of the repetitive application of stress to the bone. This application of excessive load to the bone will result in an imbalance between bone formation and bone resorption. 10% of all sport related injuries are stress fractures. [1] See also: ‘Leg and foot stress fractures’
Between 2.8 and 7% of all sport related stress fractures involve the femur.[1,2]. Although, Johnson et al. found in his study of running athletes that 20% of all the sports-related stress fractures involved the femur. [5]
In the general population there are two main groups that are more susceptible to stress fractures of the femur: Military trainees and athletes (especially runners). [3]Stress fractures of the femur can occur at the neck (highest incidence), the femurshaft and the condyle. [2] It mostly occurs in the proximal third of the femur.[1]
Femoral shaft stress fractures are not easy to diagnose. There are only few clinical signs, but they don’t allow to differentiate a stress fracture from another injury. One of this clinical signs is anterior thigh and hip pain, but this is generally vague and the location of the pain might not correlate with the location of the stress fracture.[1,2] A femoral stress fracture is also difficult to palpate due to the muscles covering the femoral shaft. [3]
Instead there are two clinical tests that can differentiate and diagnose a stress fracture of the femur. This two are the Hop test and the Fulcrum test as described by Johnson et al. [1]
The hop test and fulcrum test are positive during the physical examination. [1] For further information on the purpose and technique of the hop-test see also: ‘Hop test’. The technique of the fulcrum test is explained further below.
If these clinical tests are positive, the diagnosis must still be confirmed by a bone scan or a Magnetic Resonance Imaging scan. [1,4]

Technique

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Evidence

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Resources

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References

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