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Tibia Fulcrum Test

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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).[1]
Example using two hands and knee technique. Yellow arrows depict force vectors[2]
  • Tibia Fulcrum Test
  • Tibial Fulcrum Test
  • Fulcrum Test Tibia

Purpose

  • Evaluate the Tibia for the presence of a stress fracture

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

Pathology


Evidence

  • Rosenthal et al[1]
    • Sensitivity: 45.7%
    • Specificity: 84.4%
    • PPV: 76.2%
    • NPV: 58.9%
    • PLR: 2.93
    • NLR: 0.64
    • Overall Accuracy: 64%
  • Milgrom et al[3]
    • Sensitivity: 52%
    • Specificity: 70%

See Also


References

  1. 1.0 1.1 Rosenthal, Michael D., Mitchell J. Rauh, and James E. Cowan. "Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress Fracture." Orthopaedic Journal of Sports Medicine 10.9 (2022): 23259671221122356.
  2. Finestone, Aharon S., and Charles Milgrom. "Diagnosis and treatment of stress fractures." Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation (2012): 775-785.
  3. Milgrom, Charles, et al. "Medial tibial stress fracture diagnosis and treatment guidelines." Journal of science and medicine in sport 24.6 (2021): 526-530.
Created by:
John Kiel on 15 May 2023 05:32:43
Authors:
Last edited:
25 May 2023 06:29:17
Category: