Rovsing, Psoas, and Obturator Signs

[@Ampeehoo]

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.

[@FeynmanMedicine]

Psoas sign should be extension of hip leading to passive stretching of psoas causing irritation of retrocaecal appendix

[@kroflet]

It's not just appendicits yes or no. These tests also tell the location of inflammed appendix.

[@lonewolf-919]

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....

[@ComeAlongKay]

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.

[@johnmagar7759]

I find doing the obturator sign with patients on theirs back more practical.

[@xanthoula1979]

We should always examine our patients while being on theirs right side...!

[@xoxomag]

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...

[@maryambashir7848]

I know right. I'm confused

[@BlackShadow2009]

Psoas test can be done in two ways. Like in video or like what you said.

[@alejandrocanas9594]

2 ways to do the psoas sign! The way they showed in the video is the easiest!

[@adventurousdoglover]

My dr saw me curled over and asked to stand up straight arms up and jump. I about fell to the floor then he did these test and I almost jumped out of the room. 21 day hospital stay, drains and surgery due to mine starting to rupture

[@privateundisclosed4448]

NEVER "ON" the knee! always hold ABOVE and BELOW the knee!

[@himprabalkaushik4637]

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...

[@himprabalkaushik4637]

@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

[@abdulaibangura2569]

Nice job! Most of the negative comments are from people who are full of themselves and perform their physical examination differently.

[@bladesociety]

well said, sir

[@surbhidhuppad786]

Umm also the fact that one of the tests is definitely wrong. psoas test involves hyperextension of the thigh.

[@imanaljabbari1962]

His bow tie is so cute

[@elviko8581]

Rowsing sign will cause pain not only by peritoneal irritation but also because gas and some feces is pushed back towards the right colon

[@20MNL]

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)

[@tasnimchoudhury7682]

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.

[@chun-chengchu7143]

Actually, Psoas sign should be performed in lateral decubitus position and Obturator's sign should be performed in lying position.

[@DocAlGer]

not necesseraly,

[@dr.farisissa7531]

The way when he say internal rotation and he did external rotation crack me up 😅

[@mohamedkandel1448]

it is an internal rotation of the hip while externally rotating the knee

[@BlueRam15]

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

[@BlackShadow2009]

Psoas test can be done both ways.

[@drewdrew6904]

@@BlackShadow2009 He prob buys left handed and right handed chopsticks too

[@wannamonslo9626]

Good. Simple. Straight forward.

[@shahinshahsavari1275]

At 0:32, he mentions right lower quadrant, where the appendix is located.

[@stormin1515]

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.

[@jesusalbertomartinezcorona3798]

That is Blumberg sign, not Rovsing.

[@blueworldadam]

It seems he didn t study well

[@ChrisNP87]

@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). :)

[@matthewcastro757]

* 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

[@MuhammadIsABear]

That's not Rovsing's, that's just rebound tenderness, indicating peritonitis which may or may not be related to appendicits.

[@alisaad3576]

This channel is gonna make you fail the OSCE DON’T WATCH

[@samm216]

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)

[@sheaschultz]

obturator (pelvic) & psoas (retrocecal)

[@arupdhar2522]

why on earth u r on the left side of the patient??

[@blueworldadam]

Haha

[@v4vndta911]

He's left-handed?

[@sheilahernandez5318]

Arup Dhar maybe he wants to face the camera 😒

[@wellali2574]

LOL .. I always get confused with that

[@drshahzaib]

Camera can be on the left side.

[@talhagrewal1609]

nice model u got there

[@salehmahdial-gburi1571]

Examination from right side 😰😡

[@MaverickGmail]

hahaha :D

[@PhuongNguyen-sl7tu]

Why should the examination be done from the right side? I really dont know.

[@MaverickGmail]

Phuong Nguyen it doesn't matter which side you perform it on, as long as you remember that appendix is on the right side.

[@PhuongNguyen-sl7tu]

lol, yeah, but whenever I take examination test, my supervisor always tell me to start from the right side.

[@mahazelrosaryapostol3956]

Because it should be done like that. Try to google “Rovsing sign” for you to know. Or try reading Bates’s Guide to Physical Examination, page 468.

[@BIO-LOGICAL10]

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.

[@sari6522]

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.

[@marlenekon4392]

YOU ARE AMAZING!

[@majdytajalden7220]

😂

[@bensonwu9293]

Can you teach me how to treat your patients?

[@peninapearl6491]

why i feel both of them are not serious?

[@balki1528]

What is reason of right lower quadrant pain if delay to bowel movements..

[@leylin7349]

Good straightforward and nice

[@oz_mar]

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.

[@sarahali8147]

Why did he do the examination on the left side of the patient ? The appendix lies in the lower right part of th abdomen

[@myemail7755]

Yes yes you are right But this sign called rovsing He must pressure on left side and the patient must feel pain in right side

[@haffi26]

I would say, so many wrong things inside this video.smh.

[@Anthony-md2bm]

I want to do my beard exactly like yours, how do you do it?

[@j.fnorfleet1969]

What is the test where you tap the foot and get abd pn?

[@ВячеславКозлов-и9ц]

“[…] 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.

[@titiamsal1102]

great job!

[@DrRock-gs8cu]

Psoas sign should be examine at lateral decubitus and obturator at supine

[@abigaelkinda339]

Thank you, was looking for such comment,because he got ne confused from what I know

[@medicerror101]

thnku so much for the lady

[@bruceleehiiiyaaa]

you aren't going to show any OMM techniques to cure her of appendicitis??

[@CleoandCoco]

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.

[@bruceleehiiiyaaa]

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.

[@CleoandCoco]

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?

[@violetvixen0596]

+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.

[@violetvixen0596]

+violetvixen 05 www.nejm.org/doi/full/10.1056/NEJMcp1215006?rss=mostViewed&

[@paracelia]

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!

[@cyaranbazen8541]

So many casuals wondering about him being on the left side.

[@MuhammadRashidd]

Pain in hypogastrium in obturator sign

[@yaredtadesse4138]

why she wearing not matching socks doe!!!

[@MuhammadIsABear]

Because med school will lead even tidy people to shit like not folding their clothing and picking it out of a pile.

[@johnmagar7759]

Whenever possible it is best to move yourself than to move the patient.

[@malekbelhaj5376]

Beautiful patient 😍

[@CSoulsword]

There is only one positive thing in this video, the girl is hot as hell, everything else is plain wrong.

[@gautamx3873]

Legs should be flexed during abdominal examination!

[@FolakeBamigboye]

Times used to be very Challenging, I had the worst days of my life living with type 2 Diabetes, I appreciate you so much Dr Igudia, You have restored me my life that was lost already . Thank you so much for curing me of my diabetes with your natural Herbs.

[@Icepoddy]

Hi ma'am, what do you mean by "curing types 2 Diabates with natural herbs"? What herbs are you referring to? Just a curious med student here. Thank you.

[@carolgreenhill5684]

This needs a title relating to appendicitis, not psoas

[@ELMV403]

Great video

[@nerdowlesa]

Why’s her socks multicolored and his bangle so heavy....

[@baraatalib8979]

Thank you 👏

[@briannacook42]

whats the point of all this? we know you're just going to order a CT scan

[@StephOzz]

🤣🤣🤣🤣🤣

[@jmj7568]

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.

[@graveyardshadow293]

🥴🤣🤣🤣🤣🤣

[@alexsmbewejustice5222]

These are physical examination used to confirm for appendicitis

[@mddanish2829]

Baldwin sign?????

[@samismnurse]

Helpful video but the guy (examiner) caught my attention. Hey guys, who among you here notice his bulge?? LOL

[@AhmedMD]

+Pinoy Etchetera He looks gay though !!

[@samismnurse]

haha.. well perhaps youre right!

[@sakitperut123]

only a gay can notice that

[@SerDerpish]

DAMN YOU I CAN'T UNSEE IT NOW

[@sarahsmith5033]

Pinoy Etchetera $

[@canitomiguel]

i've seen a lot of ppl complaining about the side the examinator is, but is there a reason why the examinator must be in the right side?

[@SerDerpish]

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

[@thomasmartin3471]

Because the earth is flat

[@srishtichhabra2863]

Rovsing’s sign is done on left lower quadrant

[@kathconserv]

srishti chhabra which is what he did.

[@ماجدحموديعودهفليح]

Very nice

[@ComeAlongKay]

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.

[@ArtyHusam]

Very cute patient 😉😉

[@abdullahal-shimri3091]

she looks like a model

[@rustler08]

Alright, creeper

[@libertarianassfuck7635]

@@rustler08 😏

[@ilovegod0106]

thank you for the excellent video.

[@غيمغيم-خ7ه]

تعبت شوكت اشوف الفديو وانه متخرجه

[@saudsherzaman7082]

1st thing the dude is on left? Psoas is wrong? This video is a disaster

[@veronicarios7683]

This gotta be a joke. There's so many mistakes in this video

[@medcnspconfidencennunuselekane]

cut some slack for this guy at least he tried

[@JB-cg1rn]

thank you miss perfection.

[@rustler08]

Alright Ms. Facebook Degree.

[@hannaab9336]

It’s all correct 😂 are you ok

[@dannyhigh5]

I can''t focus on what he's saying because I get distracted on how hot and cute he is. What's his name?? 😄

[@hooshangranji2673]

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.

[@Rabinex_Prime]

Exam should have to strat from right side

[@MaverickGmail]

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.

[@dineshlama7164]

I agree with "good choice of patient " :)

[@sunakshiaggarwal5153]

its not psoas sign , its baldwings sign

[@abasinsafdarkhan3468]

the first one was not Rovsing !

[@bengtperman2488]

the first one was Emil Perman perman-rovsing sign

[@Princessfinafine]

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

[@kunoweil7294]

Tedt with the lot of Towel

[@MuhammadHaris-rj8ku]

We can we find such a patient 😅

[@lloydstuartm.d.5625]

CT scan and CBC usually does the trick for me.

[@laylow1388]

😂🤣. 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

[@Bromocriptine777]

So if patient presents with RLQ pain, just go straight to CT scan & CBC?

[@deborahtsabur7774]

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..

[@lloydstuartm.d.5625]

@@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.

[@lloydstuartm.d.5625]

@@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!

[@hikmawanpriyanto15]

Is it wrong..?

[@memea5493]

you are standing in the left side of the pt. 😕

[@দূরেকোথাও-ঙ৭ট]

I dnt knw why and who created this rules???? why cant someone examine from left.. He needs the finding...not the side.

[@AbdullahAlMomenRobin]

Do the procedure from the right side

[@amypai2525]

0:55 psoas sign

[@Agtsmirnoff]

I love redheads!

[@jdsspace718]

Sr. Please precise the explaination by using anatomical terms.

[@fatimajabar3340]

البيشنت تخبل

[@drmahmoudshabaan8716]

very good

[@HealthOO7]

Hmm that beauty cutie tho🥰🥰

[@liousevropaecvstos7711]

That waist dayum

[@sobster123]

@@liousevropaecvstos7711 ikr curves

[@readinreversetihs569]

Not negative sign but absence of sign..

[@DC-sr7gu]

shes cute

[@doctormaity7]

First of all the examination procedure is WRONG. You should stand on the patient's right side, and NOT left side. I think this rule is universal.

[@ecmoney801]

Some are complaining that the appendix is on the right side, and he performed on the left side. That is true that the appendix is on the right side, except for in very very rare cases the person could have situs inversus, the appendix may be on the left side

[@moahmed1477]

We watch for her wist u will filled if u take this😂

[@MirandoDentroo]

la exploración se realiza de lado derecho de paciente, jajajaja y ademas trae calcetines que no son pares

[@patriciaweber2983]

The patient gave me weird vibes she looked at the dr very provocatively then at 1:33 as she goes to turn on her side she lifts her hips again very provocatively. I can tell the dr looked uncomfortable.

[@عبدالحفيظمحمد-ن7م]

He erect

[@doubleg992]

damn she's fit

[@yoluis5202]

Wrong rovsing's sign

[@levine0074]

unfocused cauz the pattient really sexy

[@ebtisam403]

thank you

[@preciouscm23]

thank you!!!!

[@bluesky5320]

man your rovsing sign test is 100% wrong