Up to what age are symptoms elicited by jarring movements relevant in musculoskeletal or neurological conditions?

Dunphy's Sign and Jarring Maneuvers in Appendicitis

Dunphy's sign (pain with coughing or jarring movements) is most clinically relevant in children and young adults, typically under 40 years of age, as appendicitis predominantly affects this age group, though the sign itself has no strict upper age limit for elicitation.

Age-Related Considerations

The relevance of Dunphy's sign and jarring-elicited pain relates directly to the epidemiology of acute appendicitis rather than an age-based limitation of the physical examination technique itself:

• Peak incidence of appendicitis occurs in the second and third decades of life, making these maneuvers most frequently applicable in pediatric and young adult populations 1

• No specific upper age cutoff exists for eliciting these signs—they can be positive at any age when peritoneal irritation is present 1

• Clinical presentation varies with age: Older adults may have atypical presentations with less pronounced peritoneal signs, making jarring maneuvers less sensitive but not invalid 1

Clinical Application Across Age Groups

Children and Adolescents

• Jarring maneuvers are particularly useful as children may have difficulty localizing pain or describing symptoms accurately 1
• The test can be performed by having the child jump, walk on heels, or ride over a speed bump in a vehicle 1

Young to Middle-Aged Adults (Under 40)

• This represents the highest-yield population for Dunphy's sign given the peak appendicitis incidence 1
• Cough test and heel-drop jarring are most reliable in this age group 1

Older Adults (Over 60)

• While the sign can still be elicited, sensitivity decreases due to:
  • Atypical presentations of appendicitis 1
  • Reduced peritoneal inflammatory response with aging 1
  • Higher rates of perforation at presentation, which may paradoxically reduce pain 1

Important Clinical Caveats

The absence of pain with jarring does not exclude appendicitis, particularly in:

• Very early appendicitis before peritoneal involvement 1
• Retrocecal appendix location where peritoneal irritation may be minimal 1
• Perforated appendicitis with localized abscess formation 1
• Elderly patients with diminished inflammatory responses 1

False positives can occur with any cause of peritoneal irritation, including other intra-abdominal pathology, making the sign sensitive but not specific 1