What are the less common signs of appendicitis?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

The following accessory signs may be present in a minority of patients:

  • Rovsing sign (RLQ pain with palpation of the LLQ): Suggests peritoneal irritation

  • Obturator sign (RLQ pain with internal and external rotation of the flexed right hip): Suggests the inflamed appendix is located deep in the right hemipelvis

  • Psoas sign (RLQ pain with extension of the right hip or with flexion of the right hip against resistance): Suggests that an inflamed appendix is located along the course of the right psoas muscle

  • Dunphy sign (sharp pain in the RLQ elicited by a voluntary cough): Suggests localized peritonitis

  • RLQ pain in response to percussion of a remote quadrant of the abdomen or to firm percussion of the patient's heel: Suggests peritoneal inflammation

  • Markle sign (pain elicited in a certain area of the abdomen when the standing patient drops from standing on toes to the heels with a jarring landing): Has a sensitivity of 74% [2]

See Clinical Presentation for more detail.


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