Fulcrum Test Tibia | Tibial Stress Fracture Screening

Medial tibial pain is a very common symptom in athletic and military populations. The presence of pain in this area usually means one of two things: Medial tibial stress syndrome or a medial tibial stress fracture. The latter is by far of most concern to healthcare providers as absolute rest might be indicated to prevent the stress fracture from evolving into a frank fracture of one cortex. While stress fractures and MTSS have commonalities, there are a couple of history items that can be used to distinguish them from each other. Furthermore, orthopedic tests can be used to help with the diagnosis. One such test is the fulcrum test at the tibia.

According to a study by Milgrom et al. (2021) the fulcrum test had a sensitivity of 52% and a specificity of 70%. For this reason, its clinical value as a stand-alone test is weak.

To perform this test, have your patient in the supine position. Then, the examiner places his or her knee against the lateral border of the lower limb at the midshaft of the tibia that is used as a fulcrum. Now, grip the inside of the patient’s lower leg just below the knee with one hand and just above the ankle with your other hand and forcefully press the tibia against your knee.

This maneuver produces a tension force on the medial tibial cortex. This test is positive if pain is reproduced at the medial tibia.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other orthopedic tests to assess for stress fractures are:

• Fulcrum Test (Hip)
• Hop Test (Tibia)

References

Milgrom, C., Zloczower, E., Fleischmann, C., Spitzer, E., Landau, R., Bader, T., & Finestone, A. S. (2021). Medial tibial stress fracture diagnosis and treatment guidelines. Journal of science and medicine in sport, 24(6), 526-530.