OnExam

Rebound tenderness is a palpation maneuver often used to help establish the presence of peritoneal inflammation which may indicate peritonitis.

Performing the Test

  1. Have the patient lie in the supine position
  2. Survey the abdomen for the point of maximum tenderness
  3. Slowly and firmly press down on this spot with sufficient force to depress the peritoneum.
  4. As you quickly withdraw your hand, observe the patient for signs of pain.
  5. Ask the patient if it hurt more as you pushed in or as you let go.
  6. The test is considered positive if there is more pain elicited on the rapid removal of pressure than on its slow application.

Interpretation

  • It should be noted that this test can be extremely painful to patients.
  • In one study, rebound tenderness was found to carry a sensitivity of 95% and specificity of 20% for acute appendicitis. The same authors noted a positive likelihood ratio of 1.2 and negative predictive value of 81.3%.

References

  1. Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Wolter Kluwer Health; 2009.
  2. Alshehri MY, Ibrahim A, Abuaisha N, Malatani T, Abu-Eshy S, Khairulla S, Bahamdan K. Value of rebound tenderness in acute appendicitis. East Afr Med J. 1995; 72(8): 504-6.
  3. McGee, S. Evidence-Based Physical Diagnosis. 2nd ed. Philadelphia, PA: WB Saunders Co.; 2007.