Fulcrum Test | Femoral Stress Fracture Screening

The Fulcrum Test of the hip is an easy orthopedic test that can be used as a screening to rule out femoral stress fractures.
According to Reiman et al. (2015), the Fulcrum test has a reported sensitivity of 88 to 93% and specificity of 13 to 75%, which is why we give it a moderate clinical value.

To conduct the test, the patient is sitting on the bench and is asked to lean back on their hands.
You’re going to stand or kneel on the side to be tested.
Then, first place your forearm distally under the thigh to be tested.
With the other hand placed on the dorsum of the thigh, press down gently.

In case symptoms are not reproduced, move the forearm more proximally and repeat the procedure.
What you are trying to do is to provoke a suspected stress fracture by using the forearm as a fulcrum. 

A positive test will result in sharp pain and likely apprehension.

Other common tests to screen for fractures in different body parts are:

• Canadian C-Spine Rules (Cervical Spine)
• Elbow Extension Test (Elbow)
• Caradeniz Wrist Rules (Wrist)
• Supine Sign (Thoracic Spine)
• Closed-Fist Percussion Test (Thoracic Spine)
• Tuning Fork Auscultation Test
• Patellar Pubic Percussion Test (Femur)
• Ottawa Knee Rules (Knee)
• Ottawa Ankle Rules (Ankle & Foot)

Reiman, M. P., Mather, R. C., & Cook, C. E. (2015). Physical examination tests for hip dysfunction and injury. British journal of sports medicine, 49(6), 357-361.