Rovsing's sign
Pain in right lower quadrant from left-sided pressure.
Rovsing's sign is a clinical sign of appendicitis, named after the Danish surgeon Niels Thorkild Rovsing. It is present when palpation of the left lower quadrant of the abdomen increases pain felt in the right lower quadrant. The phenomenon was first described by Swedish surgeon Emil Samuel Perman.
Quick Facts
- Differential
- appendicitis
Facts from the source article.
Referral of pain
Unlike pain signals from muscles, those from deep within the intestines are poor at pinpointing a specific spot on the abdominal wall. For instance, pain from a stomach ulcer or gallstone can be perceived by the brain as coming from the stomach, liver, gallbladder, duodenum, or the start of the small intestine, often referring to the upper middle abdomen, the epigastrium. Since the appendix is part of the intestine, it follows this same referral pattern. Early, mild inflammation of the appendix can cause vague irritation around the belly button. If the inflammation worsens, it can irritate the peritoneum, the thin lining inside the abdominal cavity. At this point, the pain becomes localized. Pressing on the muscles of the right lower abdomen near a severely inflamed appendix stretches those muscle fibers and triggers pain.
Process
Rovsing's sign is a clinical test used to check for irritation in the abdomen. To perform it, a doctor presses on the left lower quadrant, which is far from where the appendix usually sits in the right lower quadrant. This pressure shifts the contents of the left side, stretching the entire peritoneal lining. If the peritoneum is inflamed in a specific spot, that stretching will cause pain only there. In appendicitis, the pain is felt in the right lower quadrant even though the pressure is applied elsewhere. A positive result means the patient feels pain in the right lower quadrant when the left side is pushed, suggesting an inflamed organ or tissue in that area. While the appendix is the most common suspect, other structures like the bladder, uterus, ascending colon, fallopian tubes, or ovaries can also produce this sign. If the pressure causes only left-sided pain or pain on both sides, a different cause is likely. The same eponym is also used for a symptom in horseshoe kidney, where hyperextending the spine triggers abdominal pain, nausea, and vomiting. Despite being a common test when appendicitis is suspected, Rovsing's sign has not been properly studied for sensitivity or specificity, and some doctors now consider it an outdated exam technique.
More in Symptoms and Signs: Digestive System and Abdomen
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