Test library › Mid-back & ribs
Supine sign (severe pain lying flat)
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.
Treat with caution (see below)Likelihood ratios calculated from the study's unrounded 81.25% and 93.33%; not published by the authors.
Its negative likelihood ratio reaches the usual rule-out threshold, but the book does not count it as a reliable rule-out test.
Caution: One study of 83 patients already suspected of fracture; never independently re-tested.
What the numbers mean
- Positive result: see the caution above before relying on this result.
- Negative result: see the caution above before relying on this result.
Source
Langdon J, Way A, Heaton S, Bernard J, Molloy S. Vertebral compression fractures — new clinical signs to aid diagnosis. Ann R Coll Surg Engl. 2010;92(2):163–166. PubMed · 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.