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
- Have the patient lie in the supine position.
- Passively flex the patient’s right hip and rotate the leg internally at the hip.
- If the patient feels pain in the right lower quadrant, it is a positive test.
- 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.
- Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Wolter Kluwer Health; 2009.
- McGee S. Evidence Based Physical Diagnosis, Second Edition. St. Louis, MO: Saunders Elsevier; 2007.
- Wagner JM, McKinney WP, Carpenter JL. Does This Patient Have Appendicitis? JAMA. 1996; 276(19): 1589-1594.