Tibia Fulcrum Test

Other Names

Demonstration of the tibial fulcrum test using the hand to produce the force. The arrow depicts the direction of force application on an individual with pain over the medial tibia (star).

Example using two hands and knee technique. Yellow arrows depict force vectors

• Tibia Fulcrum Test
• Tibial Fulcrum Test
• Fulcrum Test Tibia

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Purpose

• Evaluate the Tibia for the presence of a stress fracture

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Description

• The patient is supine
• The examiner applies a force on the opposite side of the tibia to the pain
  • For example, if the pain is medial, apply force on the lateral side
• The hand or knee can be used to apply the force
• The force is perpendicular to the the bone
• The opposite side of the leg is gripped for stability and to create a fulcrum
• This produces a tension force across the medial tibial cortex
• Positive test
  • Reproduction of the patients pain

Modification

• A dynamometer can be used to assess the magnitude of force application
  • This creates consistency in performance of test
  • Not typically required in practical application

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Pathology

• Tibial Stress Fracture

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Evidence

• Rosenthal et al
  • Sensitivity: 45.7%
  • Specificity: 84.4%
  • PPV: 76.2%
  • NPV: 58.9%
  • PLR: 2.93
  • NLR: 0.64
  • Overall Accuracy: 64%
• Milgrom et al
  • Sensitivity: 52%
  • Specificity: 70%

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See Also

• Leg Pain Main
• Physical Exam Leg

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