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 the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...

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 A flexor is a muscle that flexes a joint. In anatomy, flexion (from the Latin verb ''flectere'', to bend) is a joint movement that decreases the angle between the bones that converge at the joint. For example, one’s elbow joint flexes when one ...

in the

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

, 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 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 * Tr ...

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 Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than ...

results, it is a "positive psoas sign". The pain results because the psoas borders the

peritoneal cavity The peritoneal cavity is a potential space between the parietal peritoneum (the peritoneum that surrounds the abdominal wall) and visceral peritoneum (the peritoneum that surrounds the internal organs). The parietal and visceral peritonea are lay ...

, 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 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', lyi ...

, so a positive psoas sign on the right may suggest

appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a rup ...

. 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 thigh and present as a swelling in the region. T ...

. 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 their ...

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, vag ...

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 until ...

(1881–1974), an English surgeon.

References

External links

Acute appendicitis review in American Family Physician
{{Digestive system and abdomen symptoms and signs Medical signs

See also

References

External links