Psoas sign

Psoas sign
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The Psoas sign is a clinical indicator used in the diagnosis of appendicitis. It is named after the psoas major muscle, which is located in the lower lumbar region of the spine and extends through the pelvis to the femur. The sign is elicited by passively extending the patient's hip or by having the patient actively flex the hip against resistance. Pain elicited during these maneuvers suggests irritation of the psoas muscle, which can occur in cases of appendicitis when the inflamed appendix is in close proximity to the muscle.

Clinical Significance

The psoas sign is particularly useful in diagnosing appendicitis when the appendix is located in a retrocecal position, where it lies behind the cecum and may not cause the typical right lower quadrant pain. In such cases, the inflamed appendix can irritate the psoas muscle, leading to pain during hip extension or flexion.

Examination Technique

To test for the psoas sign, the patient is usually positioned in one of two ways:

1. Passive Extension: The patient lies on their side with the knees extended. The examiner extends the patient's hip by pulling the leg backward. If this maneuver elicits pain, the psoas sign is considered positive.

2. Active Flexion: The patient lies supine and is asked to flex the hip against resistance. The examiner places a hand on the patient's thigh and asks them to lift the leg while the examiner applies downward pressure. Pain during this maneuver also indicates a positive psoas sign.

Differential Diagnosis

While the psoas sign is most commonly associated with appendicitis, it can also be positive in other conditions that cause irritation of the psoas muscle, such as:

- Psoas abscess - Diverticulitis - Pelvic inflammatory disease

Limitations

The psoas sign is not specific to appendicitis and should be interpreted in the context of other clinical findings and diagnostic tests. A positive psoas sign alone is not sufficient to diagnose appendicitis, and further evaluation with imaging studies such as an ultrasound or CT scan may be necessary.

Also see

• Obturator sign
• Rovsing's sign
• McBurney's point
• Rebound tenderness