The Rovsing sign (RLQ pain with palpation of the LLQ) suggests peritoneal irritation in the RLQ precipitated by palpation at a remote location. The obturator sign (RLQ pain with internal and external rotation of the flexed right hip) suggests that the inflamed appendix is located deep in the right hemipelvis. The 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.
There comments are very helpful. It also helps how you all keep pointing out the same stuff in order to show how smart you are while not seeing that ton of other people pointed out the same things already. So, even if you’re right, you’re mostly redundant.
Obturator test is done on patient lying in Supine position.... Psoas test is done on left decubitus .... For eliciting Rovsing sign, examining from left side is unnecessary....
ummm I was under the impression Psoas sign is passive extension of the thigh while the patient is lying to the left. And the obturator sign is passive internal rotation of the hip while lying flat...
Correction: Psoas sign - done with patient lying on her L side, with R thigh passively extended -> + if with RLQ pain elicited Obturator sign - patient lying on her back, with R knee flexed and hip joint internally rotated -> if w RLQ pain elicited
Rovsing sign is positive not because of the fascia rubbing against appendics but actually due to a rightward shift of the loops of ileum pushing thr inflammed appendix...
@Anne Boleyn god has been merciful to me as i havent had the fate of experiencing the pain of appendicitis...but this is whats written in a highly respected book for surgery clinics in india as well as abroad
nice..but it will be better if u mention the significant of each signs in regards of the position of the appendix .. retroceacel (obturator).. pelvic (rovsing) and the psoas(pelvic)
Good effort but all of this is WRONG. Rovsing's sign is where you palpate deeply and then let off suddenly to see if there's referred pain in McBurneys Point due to rebound tenderness (aka inflammation of peritoneam). Psoas is PASSIVE EXTENSION of the right thigh while the patient is on the left side. I'm not sure if the obturator demonstration is wrong but the technique is odd and made more difficult than it has to be. For obturator, patient is lying flat with knees and hips flexed (pretty much pateint's feet are flat against the table, which the whole exam should be to relax the abdomen) and then you elicit passive internal rotation of the hip joint. As for credentials, I'm a M2 in medical school preparing for my Abdominal SP exam.
@Alberto Martinez, Stomin1515 is correct. Rovsing's sign is exactly that.. press on LLQ of abdomen then quickly withdraw hand. It even states that in the Bate's Guide to Physical Examination 11th edition... Blumberg sign is done over an area of the abdomen a clinician suspects peritonitis. Psoas sign is asking the patient to lift right leg against the clinician's hand that is placed just above the right knee. You don't need to turn the patient to the side to check for obturator sign, you simply flex the right thigh at the hip with the knee bent and rotate leg internally at the hip while patient is supine (Bates 11th edition). :)
* rovsing's sign -- + pain at the Mcburneys point while applying pressure on the left lower Q. *blumberg/rebound tenderness -- + pain at the Mcburneys point after you release the left lower quadrant pressure. *psoas sign -- + pain when you instruct the patient to raise it's thigh again physicians resistance at R.knee. *oburator sign -- + pain when the patient @ supine, flexes its thigh at hip and rotate its leg internally. (no need for left side lying position) medicine 2 here
all good but that's not how the Obturator Sign works. It is flexion and external rotation of right thigh while supine (same as Rovsing's) wich creates right lower quadrant pain. It indicates pelvic abscess or inflammatory mass in pelvis (appendicitis for example)
no. you're supposed to internally rotate the hip to STRETCH the muscle and potentially irritate the appendix/peritoneum. the obturator muscle works to externally rotate the hip but that would contract the muscle. He is right in the video, you can do it on the patient's side as long as your stretching the muscle.
As they said, rules for fools, Does it really matter if hes standing right or left??!! As long as u able to do ur exam properly and ur patient is comfortable u can stand anywhere, these what so called basic stuff was set up by people. Just be flexible otherwise u will be stuck in the same same spot.
Sir, I have IBD and Yesterday I got my whole abdomen CT scan report... where it was mentioned that "No gut-related mass lesion seen.Long tortuous appendix noted,retaining oral contrast in 24 hour delayed slices-may be due to recurrent appendicular pathology in appropriate clinical setting." I Don't understand If I have appendicitis.
I’m watching it in 2020 when the first suspect of an abdominal pain is Covid19. I wanted to know if I have appendicitis but I don’t have any of these signs.
“[…] using the right hand to press the fingers of the flat left hand against the (descending) colon and then, whilst maintaining the same pressure, sliding the hand[s] towards the left flexure […]” Rovsing T. Indirektes Hervorrufen des typischen Schmerzes an McBurney’s Punkt. Ein Beitrag zur Diagnostik der appendicitis und typhlitis. Zentralbl Chir. 1907;34(43):1257-1259.
676 doctors are going to fail the abdominal exam! fix it before the number hits 1000 please!! try playing this video in front of a mirror and re-record the reflection! but good choice of patient.
Comparing all other videos that I've seen, this one was more unprofessional. The examiner's position, the SP's gesture, the last exam and the camera's wrong angle and at last the SP's replacement on the couch were not done appropriately.
Rovsing sign/ symptom isn't about to press, but caress the colon descendent or ascendent in caecum direction! What you did was the Blumberg sign! Is wrong information!
If the people in the comments are doctors really helps reinforce how crazy arrogant and off putting that group is. Their way is the only way and the concept of constructive criticism rather than rude and derisive nitpicks seems foreign to them.
But you might as well do an US if pregnancy is considered and the urine pregnancy test results are delayed....CT abdomen/ pelvis in these cases are risky to say the least. Just my two cents.
😂🤣. Couldn't help but think the same thing. Did all these stuffs early on in my career but considering how litigious practising medicine in western countries is, I wonder if physical examination findings are still enough as they once were
I’ve had two ct’s and an mri. None could visualize my appendix. Still having pain, no answers just a lot of “probablys.” You probably don’t have it because x,y,z. Frustrating to accept undefinitive explanations..
@@Bromocriptine777 pretty much, yes if they still have an appendix. I've been burned on a normal physical examination and normal labs. They only time it's no is if the patient is pregnant - then we often admit and watch or get an MRI.
@@deborahtsabur7774 If you've been experiencing RLQ abd pain for a while then it's not your appendix. Appendicitis progresses quickly so if you've had pain for a while then endometriosis should be considered. Talk with a gyn for their recommendations. Imaging often cannot "see" endometriosis. Good luck!
bruceleehiiiyaaa Like what? What evidence based medicine out there indicates anything other than appendectomy? You can try some other stuff if you don't mind a ruptured appendix and further complications.
Aaron Powell you can use OMM to gently push the contents back into the appendix and manipulate the ileocecal valve to close off the section so it heals naturally.
I'm all about avoiding surgery when possible, but your explanation doesn't make much sense when you understand the etiology of appendicitis. What kind of training do these people have who do this?
+Aaron Powell Those trained in OMM have a medical degree as well as extensive knowledge of visceral and somatic dysfunction and their treatment. Below is a link to a recent study in regards to the necessity of surgery vs watchful waiting with ABX (spoiler alert: surgery is not always indicated). OMM is considered an adjuvant therapy to standard of care, so of course a DO would not attempt OMT on an acute patient presenting with appendicitis d/t possibility of rupture. I am currently a third year medical student at an Osteopathic medical school and I have not come across an osteopathic manipulation that is indicated for acute appendicitis.
This is wrong info. You should actually take this video down. The only test that’s correct is the Rovsing sign. The test you referred to as the psoas sign is actually the obturator sign and vice-versa regardless of wether or not you did the tests correctly or stayed on the left or right of the patient. Hope no one watched this before taking an exam
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because of the Step 2 CS. If you are not on the right of the patient, they deduct points from your score. For some reason. It makes no sense but that's why
