Rovsing Sign
Introduction
Rovsing sign, first described by Niels Thorkild Rovsing in 1907, involves deep palpation of the left lower quadrant with an upward sliding motion along the descending colon toward the splenic flexure. Rovsing aimed to trigger typical pain in the right iliac fossa by pressing on the left, using a technique where his right hand applied pressure onto his left hand, positioned flat against the abdomen. The hands then slid upward toward the left colonic flexure to compress the descending colon.[1]
Purpose
Rovsing sign is a classic test for diagnosing appendicitis. In this indirect rebound test, the examiner presses on the left lower quadrant, away from the typical area of appendiceal pain. A positive result occurs if the patient feels rebound pain in the right lower quadrant when the pressure is released.[2]
Technique
These steps should be followed when performing the test:
1. Positioning the Patient:
Have the patient lie flat on their back on an examination table, ensuring they are relaxed.
2. Applying Pressure:
Slowly and gently press into the left lower quadrant of the abdomen with a gradual, steady pressure.
3. Releasing Pressure:
Gradually release the pressure from the left lower quadrant.
4. Observing for Pain:
A positive Rovsing sign is indicated if the patient experiences sudden pain in the right lower quadrant upon release. This may suggest appendicitis.[3]
This video shows how to use the test:
Evidence
Rovsing sign shows predictive value for diagnosing acute appendicitis, with positive likelihood ratios ranging from 1.5 to 4.23. Sensitivity across studies varies from 19% to 75%, and specificity ranges from 58% to 93%. This wide variation likely results from differences in how the test is performed in each study.[5]
References
- ↑ Yale SH, Tekiner H, Yale ES. Signs and syndromes in acute appendicitis: A pathophysiologic approach. World Journal of Gastrointestinal Surgery. 2022 Jul 7;14(7):727.
- ↑ Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. International journal of general medicine. 2012 Sep 26:789-97
- ↑ Osmosis.org. Available at: https://www.osmosis.org/answers/Rovsing-sign (Accessed: October 29, 2024).
- ↑ Youtu.be. Available at: https://youtu.be/6I03eiLO_lU?si=wuAEqxMNlEeZSIm3 (Accessed: October 30, 2024).
- ↑ Rastogi V, Singh D, Tekiner H, Ye F, Kirchenko N, Mazza JJ, Yale SH. Abdominal physical signs and medical eponyms: physical examination of palpation part 1, 1876–1907. Clinical Medicine & Research. 2018 Dec 1;16(3-4):83-91.