Fulcrum Test
Definition
The Fulcrum Test is a clinical diagnostic procedure used to identify femoral shaft stress fractures. This test helps healthcare professionals detect fractures by applying a controlled force to the femur, eliciting pain or discomfort if a stress fracture is present. It is commonly used in orthopedic assessments to aid in early detection and treatment planning. Stress fractures of the femoral shaft are uncommon and mostly occur at the proximal third of the femur[1]
Clinically Relevant Anatomy
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 of the pelvic bone, forming the hip joint. Meanwhile, the distal end of the femur articulates with the tibia and patella, forming the knee joint. The femur also serves as a crucial site for the origin and insertion of various muscles and ligaments, playing a vital role in movement and stability.
For more detailed information on the anatomy of the Femur
Purpose
The fulcrum test is used to aid the diagnosis of femoral shaft stress fractures. It is also useful in assessing the healing response.
If the clinical test is positive during the physical examination, the diagnosis is confirmed by a bone scan or a Magnetic Resonance Imaging scan(MRI)[2]. MRI helps to differentiate stress fractures from other pathological processes, especially neoplastic ones.[3]
Technique
During the Fulcrum Test, the patient is seated on the examination table with their lower legs dangling. The examiner places one arm beneath the symptomatic thigh, using it as a fulcrum. The fulcrum is moved from the distal to proximal thigh while gentle pressure is applied to the front of the knee with the opposite hand. When the fulcrum aligns with the site of a stress fracture, this pressure elicits sharp pain and apprehension from the patient. The contralateral leg serves as a negative control, ensuring accuracy. Notably, the location where the Fulcrum Test is positive consistently corresponds to the site of the stress fracture, as confirmed by scintigraphy or radiography. [4]
Evidence
| Reliability[5] | Sensitivity[5] | Positive Likelihood Ratio[5] | Negative Likelihood Ratio[5] |
|---|---|---|---|
| N/A | 1.00 | ∞ | 0.00 |
Clinical Relevance
The Fulcrum Test is a valuable tool for physicians to localize pain and aid in diagnosing femoral shaft stress injuries. These fractures are typically managed conservatively through rest, activity modification, and protected weight-bearing. The duration of treatment varies depending on the individual, with the recommended period of relative rest lasting approximately 12 weeks.[6]
Related Tests
References
- ↑ 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.
- ↑ Martin SD, Healy JH, Horowitz S. Stress fracture MRI. Orthopedics. 1993 Jan 1;16(1):75-8.
- ↑ 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.
- ↑ 5.0 5.1 5.2 5.3 Snyder J. John Snyder, DPT.
- ↑ Kiel J, Kaiser K. Stress reaction and fractures. InStatPearls [Internet] 2019 Jun 4. StatPearls Publishing.