Athletic Training & Sports Medicine Center

 

Examination Links:

 

Fulcrum Test

Examination type Joint Instability
Patient & Body Segment Positioning Lying supine on the examination table. Involved shoulder should be abducted to 900 and externally rotated with the elbow flexed to 900.
Examiner Position The examiner should be standing next to the patient on the involved side.  Make a fist with one hand and place it under the patients humerus to act as a fulcrum while placing the other hand at the athlete’s elbow in order to apply force.
Tissues Being Tested

Anterior ligaments of the shoulder, rotator cuff muscles, labrum, and the head of the humerus

Performing the Test Using the fist under the humerus as a fulcrum, apply a downward force on the elbow with one hand and use the fist to apply a mild anterior directed force to the posterior humeral head.  This will cause the humeral head to translate anteriorly.
Positive Test A positive test is indicated if the patient shows apprehension, indicates pain with translation, or if alarm shows on the patients face.   If the patient has previously dislocated or had a subluxation he may describe the pain as similar to experiencing this injury.
Interpretation Pain or apprehension indicate anterior instability
Common errors in performing exam Application of pressure on wrong spot. Examiner has wrong positioning. Patient does not comply fully with examiners instructions. Patient is in wrong position.
Factors possibly resulting in misinterpretation Improper hand positioning can easily mislead the examiner while he or she is performing the test. The test should be performed very slowly. If it is performed rapidly the glenohumeral joint may dislocate from its joint capsule causing further pain and injury to the patient. Not performing a bilateral comparison on the non-injured joint could also mislead the examiner in his interpretation of the injury.
Related tests Anterior apprehension test (Crank Test), Relocation Test (Fowler Test or Jobe Relocation Test), Rockwood Test, Rowe Test, Prone Anterior Instability Test, Andrews’ Anterior Instability Test, and the Anterior Drawer Test for the shoulder
References

Booker, James M & Tibideau, Gary (2000) Athletic Injury Assessment  (4th ed). ST. Louis McGraw Hill. Pg.

Magee, David (2002) Orthopedic Physical Assessment Philadelphia Saunders.
Links: www.orthop.washington.edu/uw/evaluation/tabID__337... , www.nwtsportsmed.com  
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