OnExam

This test, sometimes referred to as “indirect tenderness”, is a palpation maneuver often used to help establish the diagnosis of appendicitis or general peritonitis. For the former, it can be used in conjunction with the psoas sign and obturator sign.

Performing the Test

  1. Have the patient lie in the supine position.
  2. Deeply palpate the left lower quadrant.
  3. A positive test is when the palpation results in an increase in pain the right lower quadrant.

Interpretation

  • As an acutely inflamed or infected organ begins to irritate the peritoneal lining of the abdominal cavity, well-localized pain begins to develop at that site. When an examiner uses moderate pressure to palpate a quadrant far from the irritation, the peritoneum stretches and transmits the force to the acutely tender area.
  • Rovsing’s sign is not particularly useful. Its sensitivity for detecting appendicitis is 22-68% but its specificity is 58-96%. Further, the positive likelihood ratio for diagnosing appendicitis is only 2.5 while the negative ratio is 0.7.

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.