The obturator sign, also called Cope's obturator test, is an indicator of
irritation
Irritation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant. Irritants are typically thought of as chemical age ...
to the
obturator internus muscle
The internal obturator muscle or obturator internus muscle originates on the medial surface of the obturator membrane, the ischium near the membrane, and the rim of the pubis.
It exits the pelvic cavity through the lesser sciatic foramen.
The ...
.
The technique for detecting the obturator sign, called the ''obturator test'', is carried out on each leg in succession. The patient lies on her/his back with the hip and knee both flexed at ninety degrees. The
examiner
Examiner or The Examiner may refer to:
Occupations
* Bank examiner, a kind of auditor
* Examiner (Roman Catholicism), a type of office in the Roman Catholic Church
* Examinership, a concept in Irish law
* Medical examiner
* Patent examiner
* ...
holds the patient's ankle with one hand and knee with the other hand. The examiner internally rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to move only inward. This is flexion and internal rotation of the hip.
In the clinical context, it is performed when
acute appendicitis
Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, fever and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications o ...
is suspected. In this condition, the appendix becomes inflamed and enlarged. The appendix may come into physical contact with the obturator internus muscle, which will be stretched when this maneuver is performed on the right leg. This causes pain and is evidence in support of an inflamed appendix.
The principles of the obturator sign in the diagnosis of appendicitis are similar to that of the
psoas sign. The appendix is commonly located in the retrocecal or pelvic region. The obturator sign indicates the presence of an inflamed pelvic appendix.
Evidence shows that the obturator test does not adequately diagnose appendicitis, but can be used in conjunction with other signs and symptoms to make a diagnosis.
It was introduced by
Zachary Cope (1881–1974), an English surgeon.
See also
*
Markle's sign
Markle's sign, or jar tenderness, is a clinical sign in which pain in the right lower quadrant of the abdomen is elicited by the heel-drop test (dropping to the heels, from standing on the toes, with a jarring landing).
It is found in patients ...
*
Psoas sign
*
Rovsing's sign
*
McBurney's point
McBurney's point is the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the Navel, umbilicus (navel). This is near the most common location of the Vermiform appendix, appendix.
...
References
External links
Acute appendicitis review in American Family Physician
{{Digestive system and abdomen symptoms and signs
Medical signs