Rovsing’s Sign – Physical Exam

ROVSING’S SIGN:

Rovsing sign is a sign of appendicitis. If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis. In acute appendicitis, palpation in the left iliac fossa may produce pain in the right iliac fossa. Other physical examinations that helps in diagnosing appendicitis are Obturator’s sign and Psoas sign. Please watch the following Rovsing’s sign video.

How to look for Rovsing’s sign

A Rovsing sign is elicited by pushing on the abdomen far away from the appendix in the left lower quadrant as in most people the appendix is in the right lower quadrant. While this maneuver stretches the entire peritoneal lining, it only causes pain in any location where the peritoneum is irritating the muscle. In the case of appendicitis, the pain is felt in the right lower quadrant despite pressure being placed elsewhere.

Most practitioners push on the left lower quadrant to see where the patient complains of pain. If pain is felt in the right lower quadrant, then there may be an inflamed organ or piece of tissue in the right lower quadrant. The appendix is generally the prime suspect, although other pathology can also give a “positive” Rovsing’s sign. If left lower quadrant pressure by the examiner leads only to left-sided pain or pain on both the left and right sides, then there may be some other pathologic etiology. This may include causes relating to the bladder, uterus, ascending (right) colon, fallopian tubes, ovaries, or other structures.