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
- Have patient lie on their left side.
- Passively hyperextend the right hip to cause stretching of the iliopsoas muscle group.
- If hyperextension recreates the pain, the test is positive.
- Have the patient lie supine.
- Place your hand on the patient’s knee and have them flex their hip while applying resistance to their leg.
- If the pain is recreated, it is a positive psoas sign.
- 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.
- 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.