Test library › Mid-back & ribs
Closed-fist percussion test
For: Acute vertebral compression fracture
A recent collapse of a vertebra (a bone of the spine), most often from osteoporosis, when it can happen after little or no trauma.
A weak test on its ownWhat the numbers mean
- Positive result: a small shift: a positive result nudges the diagnosis up, but does not settle it.
- Negative result: a small shift: a negative result nudges the diagnosis down, but does not exclude it.
Source
Ueda T. Diagnostic Accuracy of the Head Elevation Test: A Novel Physical Examination for Vertebral Compression Fractures in Older Adults With Back Pain. Spine (Phila Pa 1976). 2026;51(15):1116–1122. Journal article (DOI) · single study
Figures as they will appear in Rule It In, Rule It Out (Trokos, forthcoming). If a newer or better study changes them, this page changes with the book. Figures last updated from the book on 2 October 2026.
Get the book for sorting chest-wall pain from the heart, lungs and aorta, and spotting the osteoporotic fracture
This page gives the published figures. Rule It In, Rule It Out adds how to do this test, what counts as positive, how to read the result, and, where studied, whether combining it with other tests helps.
Coming in late 2026 as a PDF and a paperback. Join the list to hear when it's out
One study, one test, once a month
Rule It In is a free evidence letter for musculoskeletal clinicians: one recent study explained, one examination test with its real numbers. From Trokos, publisher of Rule It In, Rule It Out.