The psoas sign, also known as Cope's sign (or Cope's psoas test
) or Obraztsova's sign,
is a
medical sign
Signs and symptoms are diagnostic indications of an illness, injury, or condition.
Signs are objective and externally observable; symptoms are a person's reported subjective experiences.
A sign for example may be a higher or lower temperature ...
that indicates
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
iliopsoas group of
hip flexors
In anatomy, flexor is a muscle that contracts to perform flexion (from the Latin verb ''flectere'', to bend), a movement that decreases the angle between the bones converging at a joint. For example, one's elbow joint flexes when one brings the ...
in the
abdomen
The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...
, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).
There are two techniques for detecting the psoas sign. One method is to have the patient lie in the supine position and lift their leg straight up while the physician places pressure on the patient's thigh. The second method is carried out by having the patient lie on his/her left side with the knees extended. 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 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.
If
abdominal pain
Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given th ...
results, it is a "positive psoas sign". The pain results because the psoas borders the
peritoneal cavity
The peritoneal cavity is a potential space located between the two layers of the peritoneum—the parietal peritoneum, the serous membrane that lines the abdominal wall, and visceral peritoneum, which surrounds the internal organs. While situated ...
, 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
Appendix (: appendices or appendixes) may refer to:
__NOTOC__ In documents
* Addendum, an addition made to a document by its author after its initial printing or publication
* Bibliography, a systematic list of books and other works
* Index (publis ...
when the patient is
supine
In grammar, a supine is a form of verbal noun used in some languages. The term is most often used for Latin, where it is one of the four principal parts of a verb. The word refers to a position of lying on one's back (as opposed to ' prone', l ...
, so a positive psoas sign on the right may suggest
appendicitis
Appendicitis is inflammation of the Appendix (anatomy), appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, fever and anorexia (symptom), decreased appetite. However, approximately 40% of people do not have these t ...
. 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
The retroperitoneal space (retroperitoneum) is the anatomical space (sometimes a potential space) behind (''retro'') the peritoneum. It has no specific delineating anatomical structures. Organs are retroperitoneal if they have peritoneum on thei ...
irritation, e.g. as caused by
hemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, ...
of an
iliac vessel.
It was introduced by
Zachary Cope (1881–1974), an English surgeon.
See also
*
Blumberg's sign
Blumberg's sign (also referred to as rebound tenderness or Shchetkin–Blumberg's sign) is a clinical sign in which there is pain upon removal of pressure rather than application of pressure to the abdomen. (The latter is referred to simply as '' ...
*
Hamburger sign
*
Obturator 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