Screening

Supine Sign | Thoracic Compression Fracture

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Supine Sign

Supine Sign | Thoracic Compression Fracture

If you see a patient with sudden back pain, that comes to you without a referral from the GP or a specialist, the first thing you want to do is to screen for serious pathologies.Osteoporotic compression fractures are the most common red flag in the vertebral spine with a prevalence of 25% in women over the age of 65 and 40% over the age of 80.

According to Langdon et al. (2010), the supine sign has a sensitivity of 81% and a specificity of 93% in the detection of symptomatic fractures of the spine.

To perform the test, simply ask your patient to lie supine on the examination bench with only one pillow. The sign is positive if your patient is unable to lie supine, due to severe pain. The reasoning behind this test is, that most compression fractures occur on thoracic level and more compression is applied to that area when the patient is asked to lie on his back. Therefore, you will hear during patient history that these patients often sleep in a chair due to their complaints. Another common test for thoracic compression fractures is the Closed-Fist Percussion Test.

 

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If you want to screen for fractures in other body parts, check out the list below:

 

References

Langdon, J., Way, A., Heaton, S., Bernard, J., & Molloy, S. (2010). Vertebral compression fractures–new clinical signs to aid diagnosis. The Annals of The Royal College of Surgeons of England92(2), 163-166.

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