OnExam

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

Performing the Test

Method #1:

  1. Have patient lie on their left side.
  2. Passively hyperextend the right hip to cause stretching of the iliopsoas muscle group.
  3. If hyperextension recreates the pain, the test is positive.

Method #2:

  1. Have the patient lie supine.
  2. Place your hand on the patient’s knee and have them flex their hip while applying resistance to their leg.
  3. If the pain is recreated, it is a positive psoas sign.

Interpretation

  • There are a few possible variations in the anatomy of the appendix. By moving the underlying muscles via the psoas sign maneuver, an inflamed appendix can be expected to cause pain.
  • A positive psoas sign does suggest appendicitis may be present, but a negative result should not change clinical decision-making. It has a sensitivity of 13-42% and a specificity of 79-97%. Its positive likelihood ratio is 2.0.

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.