OnExam

The obturator sign is a test that is often used to help in the diagnosis of appendicitis. It can be used in conjunction with the psoas sign and Rovsing’s sign.

Performing the Test

  1. Have the patient lie in the supine position.
  2. Passively flex the patient’s right hip and rotate the leg internally at the hip.
  3. If the patient feels pain in the right lower quadrant, it is a positive test.

Interpretation

  • There are a few possible variations in the anatomy of the appendix. By moving the underlying muscles via the obturator sign maneuver, an inflamed appendix can be expected to cause pain.
  • A positive obturator sign does not weigh heavily on clinical decision-making in the workup of appendicitis. It is said to have a sensitivity of only 8% and a specificity of 94%. Likelihood ratios are negligible.

References

  1. Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Wolter Kluwer Health; 2009.
  2. McGee S. Evidence Based Physical Diagnosis, Second Edition. St. Louis, MO: Saunders Elsevier; 2007.
  3. Wagner JM, McKinney WP, Carpenter JL. Does This Patient Have Appendicitis? JAMA. 1996; 276(19): 1589-1594.