The psoas sign, also known as Cope's sign (or Cope's psoas test
) or Obraztsova's sign,
is a
medical sign 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
The iliopsoas muscle (; from lat, ile, lit=groin and grc, ψόᾱ, psóā, muscles of the loins) refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are ...
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.
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
Appendix, or its plural form appendices, 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 (pub ...
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', ...
, 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
An abscess in the psoas muscle of the abdomen may be caused by lumbar tuberculosis. Owing to the proximal attachments of the iliopsoas, such an abscess may drain inferiorly into the upper medial
Medial may refer to:
Mathematics
* Medial ...
. 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
Sir Vincent Zachary Cope MD MS FRCS (14 February 1881 – 28 December 1974) was an English physician, surgeon, author, historian and poet perhaps best known for authoring the book ''Cope's Early Diagnosis of the Acute Abdomen'' from 1921 unti ...
(1881–1974), an English surgeon.
See also
*
Blumberg's sign
*
Hamburger sign The hamburger sign is used in the diagnosis of appendicitis. The sign is used to rule out that disease, with the physician inquiring if the patient would like to consume his/her favourite food. If a patient wants to eat, consider a diagnosis other t ...
*
Obturator sign
*
Rovsing's sign
Rovsing's sign, named after the Danish surgeon Niels Thorkild Rovsing (1862–1927), 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 ...
*
McBurney's point
References
External links
Acute appendicitis review in American Family Physician
{{Digestive system and abdomen symptoms and signs
Medical signs