When doing an abdominal assessment, one might find several different signs that could indicate appendicitis. We will be discussing some of these assessment findings, and how they relate to acute appendicitis. 

The McBurney point is point tenderness located in the center of the right lower quadrant, approximately 3-4cm towards the midline from the iliac spine.

Rovsing sign is a referred (indirect) tenderness in the right lower quadrant associated with rebound; it’s located in the middle of the left lower quadrant when deep palpation is applied. Pain in this location tends to escalate when pressure is released from the area.

Psoas sign is assessed by having the patient lie supine  and placing your hand just above the knee. Ask the patient to lift the right leg against resistance of your hand. This motion causes friction of the psoas muscle over the inflamed appendix, causing pain.

To assess for the obturator sign, position the patient supine with their right knee bent and leg bent at the hip. Rotate the leg internally at the hip, causing the internal obturator muscle to stretch providing indirect pressure over the appendix.

How do these relate? 

Appendicitis is highly suspected if there is tenderness at McBurney’s point, along with a secondary positive finding. The assessments above either directly or indirectly cause pressure or friction against the appendix, causing pain due to the already-present inflammation. Communicate any of these positive findings to the provider. 

Reference:  
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.

 

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