Purpose of Fulcrum test (anterior glenohumeral instability): To test if there is an anterior instability of the glenohumeral joint (1).

Patient position: Supine lying.

Examiner position: Stand facing the patient’s affected side.

Procedure: Gently flex the patient’s affected side elbow joint to 90 degrees and abduct the shoulder joint to 90 degrees, maintaining the humerus in neutral rotation. Gently perform lateral rotation of the patient’s affected shoulder joint until the end of the range. Place a fist under the affected glenohumeral joint to act as a fulcrum. Apply a mild anteriorly directed force using the fist to the posterior humeral head (to translate the humeral head anteriorly).

Alternatively, grasp the patient’s elbow and horizontally abduct the arm while in external rotation; gently lift the humeral head anteriorly creating a fulcrum (2).

Outcome: This is (Fulcrum test) positive if the patient feels pain (during anterior translation of humeral head) or apprehensive of having a subluxation or dislocation during the manoeuvre.

Reference:

1. Reinold MM, Gill TJ. Current Concepts in the Evaluation and Treatment of the Shoulder in Overhead-Throwing Athletes, Part 1: Physical Characteristics and Clinical Examination. Sports Health. 2010;2(1):39-50.
2. Wilk KE, Andrews JR, Arrigo CA. The physical examination of the glenohumeral joint: emphasis on the stabilizing structures. The Journal of orthopaedic and sports physical therapy. 1997;25(6):380-9.