The psoas sign, also known as Cope's psoas test[1] or Obraztsova's sign,[2] is a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).
The technique for detecting the psoas sign is carried out on the patient's right leg. The patient lies on his/her left side with the knees extended. The examiner holds the patient's right thigh and passively extends the hip. Alternatively, the patient lies on their back, and the examiner asks the patient to actively flex the right hip against the examiner's hand.[3]
If abdominal pain results, it is a "positive psoas sign". The pain results because the psoas borders the peritoneal cavity, so stretching (by hyperextension at the hip) or contraction (by flexion of the hip) of the muscles causes friction against nearby inflamed tissues. In particular, the right iliopsoas muscle lies under the appendix when the patient is supine, so a positive psoas sign on the right may suggest appendicitis. A positive psoas sign may also be present in a patient with a psoas abscess. It may also be positive with other sources of retroperitoneal irritation, e.g. as caused by hemorrhage of an iliac vessel.
It was introduced by Zachary Cope (1881–1974), an English surgeon.[4][5]
See also
medicine portal
Abdominal exam
Blumberg sign
Hamburger sign
McBurney's point
Obturator sign
Rovsing's sign
References
^Bhat, Sriram; M, Sriram Bhat (30 December 2012). SRB's Manual of Surgery. JP Medical Ltd. p. 1279. ISBN 978-93-5025-944-3.
^Augustin, Goran (12 May 2014). Acute Abdomen During Pregnancy. Springer. p. 8. ISBN 978-3-319-05422-3.
^Bickley, Lynn S. Bates' Guide to Physical Exam and History Taking (9th ed.). Lippincott, Williams, and Wilkins. p. 390.
^Huang, Ih-Ping; Smith, C Daniel (August 2006). "Cope's Early Diagnosis of the Acute Abdomen, 21st Edition". Annals of Surgery. 244 (2): 322. doi:10.1097/01.sla.0000230276.84612.b4. PMC 1602170.
^Silen, William (revised by) (2005). Cope's early diagnosis of the acute abdomen (21st ed.). Oxford: Oxford University Press. ISBN 0-19-517545-X.
External links
Acute appendicitis review in American Family Physician
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t
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Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
Upper
Nausea
Vomiting
Heartburn
Aerophagia
Dysphagia
oropharyngeal
esophageal
Odynophagia
Halitosis
Xerostomia
Hypersalivation
Burping
Wet burp
Defaecation
Flatulence
Fecal incontinence
Encopresis
Blood: Fecal occult blood
Rectal tenesmus
Constipation
Obstructed defecation
Diarrhea
Rectal discharge
Psoas sign
Obturator sign
Rovsing's sign
Hamburger sign
Heel tap sign
Aure-Rozanova's sign
Dunphy sign
Alder's sign
Lockwood's sign
Rosenstein's sign
Abdomen
Abdominal pain
Acute abdomen
Colic
Baby colic
Abdominal guarding
Rebound tenderness
Abdominal distension
Bloating
Ascites
Tympanites
Shifting dullness
Bulging flanks
Fluid wave test
Abdominal mass
Hepatosplenomegaly
Hepatomegaly
Splenomegaly
Jaundice
Mallet-Guy sign
Puddle sign
v
t
e
Eponymous medical signs for digestive system and abdomen
Digestive system
Gastrointestinal tract
Goodsall's rule
Chilaiditi syndrome
intussusception: Dance's sign
Lockwood's sign
appendicitis: Aaron's sign
Arapov's sign (contracture)
Dunphy sign
Markle sign
McBurney's point
Rosenstein's sign
Rovsing's sign
Sherren's triangle
Aure-Rozanova's sign
Alder's sign
pancreatitis Mallet-Guy sign
Radiologic signs: Hampton's line
Klemm's sign
Accessory
liver: Councilman body
Mallory body
biliary: Boas' sign
Courvoisier's law
Charcot's cholangitis triad/Reynolds' pentad
cholecystitis (Murphy's sign
Lépine's sign)
Nardi test
Abdominopelvic
Peritoneum
Blumberg sign
Rigler's sign
Cupola sign
Hernia
Howship–Romberg sign
Hannington-Kiff sign
Other
Fothergill's sign
Carnett's sign
Abdominal general
spleen/LUQ: Ballance's sign
Traube's sign
Castell's sign
Kehr's sign
hemorrhage: Cullen's sign
Grey Turner's sign
UpToDate Contents
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…local peritoneal irritation (sensitivity 22 to 68 percent; specificity 58 to 96 percent ). The psoas sign is associated with a retrocecal appendix. This is manifested by right lower quadrant pain with…
…exacerbated when performing movements in which the psoas muscle is stretched or extended; the "psoas sign" is pain brought on by extension of the hip. Limitation of hip movement is common, and patients …
…inflamed appendix lies in the pelvis and causes irritation of the obturator internus muscle) Iliopsoas sign (pain on extension of the right hip, which is found in retrocecal appendicitis) Rebound tenderness …
…appendicitis. A positive psoas sign consists of pain elicited when the examiner passively extends the right hip of the patient, who lies on their left side. A positive psoas sign may be seen with a retrocecal …
English Journal
Anatomic Considerations in the Lateral Transpsoas Interbody Fusion: The Impact of Age, Sex, BMI, and Scoliosis.
Mai HT, Schneider AD, Alvarez AP, Hashmi SZ, Smith JT, Freshman RD, Mitchell SM, Qin CD, Hsu WK.
Clinical spine surgery. 2019 Jun;32(5)215-221.
This is a retrospective case series. Define the anatomic variations and the risk factors for such within the operative corridor of the transpsoas lateral interbody fusion. The lateral interbody fusion approach has recently been associated with devastating complications such as injury to the lumbosac
The spontaneous restoration of the course of psoas muscles after corrective surgery for adult spinal deformity.
Tanida S, Fujibayashi S, Otsuki B, Matsuda S.
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2019 Apr;().
A previous study demonstrated that spinopelvic alignment and morphology influence a deviation in the course of psoas muscle (PM). However, it is unknown whether such deviations might be caused by a decrease in lumbar lordosis (LL) or the lateral deviation of the lumbar spine following scoliosis. The
Primary retroperitoneal liposarcoma with extensive ossification: A case report.
Xin Q, Liu X, Yu X, Ye J, Peng X, Zhou M, Zhang P.
Medicine. 2019 Mar;98(13)e14996.
Primary retroperitoneal liposarcoma, which originates from mesenchymal tissues, can rarely present with extensive ossification. A 41-year-old male patient presented with a chief complaint of discomfort around the waist for 2 months. Computerized tomography (CT) and magnetic resonance imaging suggest
Integrated anatomy of the neuromuscular, visceral, vascular, and urinary tissues determined by MRI for a surgical approach to lateral lumbar interbody fusion in the presence or absence of spinal deformity
Ebata Shigeto,Ohba Tetsuro,Haro Hirotaka
Spine Surgery and Related Research 2(2), 140-147, 2018
… We analyzed the relative anatomical position of the psoas major muscle, lumbar plexus, femoral nerves, inferior vena cava, abdominal aorta and its bifurcation, ureter, testicular or ovarian artery, kidney and transverse abdominal muscle in patients with ASD or with LSS, using preoperative magnetic resonance imaging (MRI).</p><p>Results: For patients with ASD, the L4-5 intervertebral disk was closer to the lumbar nerve plexus than it was in those with LSS (p < …
… Five days after the stent exchange, computed tomography (CT) revealed a right psoas abscess. … Computed tomography-guided percutaneous catheter drainage and treatment consisting of vancomycin, minocycline and ciprofloxacin were performed for the psoas abscess. … There has been no sign of recurrence of bladder cancer and psoas abscess at 23 months after the operation. …