Which finding on examination is most characteristic of a vertebral compression fracture?

Which finding on examination is most characteristic of a vertebral compression fracture?

• A. Point tenderness over the spinous process
• B. Pain with resisted hip flexion
• C. Numbness in the limbs without focal tenderness
• D. Paresthesias in a dermatomal pattern

Answer: (A)

Localized midline vertebral tenderness over the affected level is the hallmark finding of a vertebral compression fracture. The pain is typically abrupt and focal, and you can palpate point tenderness directly over the spinous process or vertebral body, reflecting the localized bone injury often seen in osteoporosis or after minor trauma. This focused tenderness helps distinguish it from radicular or neuropathic processes, which produce numbness or paresthesias in a dermatomal pattern or generalized neuropathic signs rather than a discrete spinal point. Pain with resisted hip flexion or leg symptoms without focal spine tenderness point to other issues such as iliopsoas involvement or peripheral neuropathy, not a vertebral fracture.

Localized midline vertebral tenderness over the affected level is the hallmark finding of a vertebral compression fracture. The pain is typically abrupt and focal, and you can palpate point tenderness directly over the spinous process or vertebral body, reflecting the localized bone injury often seen in osteoporosis or after minor trauma. This focused tenderness helps distinguish it from radicular or neuropathic processes, which produce numbness or paresthesias in a dermatomal pattern or generalized neuropathic signs rather than a discrete spinal point. Pain with resisted hip flexion or leg symptoms without focal spine tenderness point to other issues such as iliopsoas involvement or peripheral neuropathy, not a vertebral fracture.