What is Rovsing's sign?

Rovsing's Sign in Clinical Diagnosis

Rovsing's sign is a clinical examination finding where pressure applied to the left lower quadrant of the abdomen causes pain in the right lower quadrant, indicating peritoneal inflammation and commonly used in the diagnosis of acute appendicitis. 1

Correct Technique for Eliciting Rovsing's Sign

• Rovsing's sign is performed by applying pressure to the left lower quadrant of the abdomen, which causes pain in the right lower quadrant 1
• This sign is based on the principle that pressing on the left side causes movement of intestinal contents and gas toward the inflamed appendix on the right side, resulting in pain 2
• The sign is considered positive when pressure on the left side elicits pain in the right lower quadrant, suggesting peritoneal inflammation 3

Clinical Significance

• Rovsing's sign is one of several physical examination findings used to help diagnose acute appendicitis 3
• When positive in patients with undifferentiated abdominal pain, Rovsing's sign has a positive likelihood ratio of 3.52 (95% CI = 2.65-4.68) for appendicitis 3
• It is more useful for ruling in appendicitis when positive than ruling out the condition when negative 4

Historical Context

• The sign is named after Niels Thorkild Rovsing (1862-1927), a Danish surgeon who first described it in 1907 5
• Rovsing was a prominent surgeon who served as Professor of Surgery and Director of Surgery at the Royal Frederiks Hospital in Copenhagen 5
• He was known for his contributions to urological surgery and was the co-founder of the Danish Surgical Society 5

Common Misinterpretations

• There is significant inconsistency in how Rovsing's sign is described and performed in medical literature 1
• A systematic review found that many studies and textbooks incorrectly describe the technique for eliciting this sign 1
• This inconsistency has led to questionable statistical data regarding the sign's diagnostic accuracy 1

Clinical Application

• Rovsing's sign should be used as part of a comprehensive clinical evaluation for suspected appendicitis, not as a standalone diagnostic test 4
• It is most valuable when combined with other clinical findings such as pain migration to the right lower quadrant and cough/hop pain 3
• Physical examination signs like Rovsing's are particularly valuable in settings where advanced imaging may not be readily available 4

Limitations

• The diagnostic accuracy of Rovsing's sign has not been well-studied with standardized techniques 4
• A negative Rovsing's sign does not exclude appendicitis 3
• The sign's reliability may be affected by the position of the appendix, which varies among patients 4

Rovsing's sign represents one of the classic physical examination techniques that continues to have value in modern clinical practice, despite the increasing reliance on imaging studies for diagnosis of appendicitis. Proper understanding and execution of this sign can contribute to more accurate clinical assessment.