[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) › Rebound tenderness (Blumberg sign) [Clinical exam](https://durgical.com/en/clinical-exam/) · [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) # Rebound tenderness (Blumberg sign) - Sign It hurts more when the hand is lifted suddenly than when it presses the abdomen: a sign that the peritoneum is irritated. Updated 2026-11-01 **See it in 3D:** [Peritoneum](https://durgical.com/en/anatomy/peritoneum/) · [Rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/) · [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/) ## Key points - Technique: slow, deep pressure held for a few seconds, then the hand is lifted suddenly. - Positive: pain on release is greater than on pressure; the patient winces or groans. - It means parietal peritoneal irritation (peritonitis), for example in appendicitis. - A positive rebound makes appendicitis more likely, but a negative one does not rule it out. - Gentler alternatives with the same meaning: percussion tenderness, pain on coughing and pain on dropping onto the heels. ## What it is Blumberg sign, or rebound tenderness, is pain that appears or worsens when the examiner lifts the hand quickly after pressing slowly into the abdomen. It signals irritation of the parietal peritoneum, which is stretched and jolted as the wall springs back. It is a sign of localized or diffuse peritonitis; because it is uncomfortable it is tested once, at the end, or replaced by gentler options such as percussion tenderness or pain on coughing. ## The anatomy it tests - The parietal peritoneum has segmental somatic nerve supply, so its irritation gives well-localized pain. - When pressure is released, the abdominal wall and organs spring back and stretch the inflamed peritoneum. - The visceral peritoneum has only autonomic supply and does not produce rebound. ## How to elicit it - Patient supine with knees flexed; explain that a brief discomfort may occur. - Choose a site away from the pain to compare, then the suspect area (for example the right iliac fossa). - Press slowly and deeply with the fingers together and hold for a few seconds. - Lift the hand away suddenly and watch the patient's face. - Ask which hurt more, the pressure or the release, and where the pain was felt. - Do it only once; if percussion tenderness or pain on coughing is already present, rebound can be skipped. ## What a positive result means - Positive: more intense pain on release, localized to the inflamed area. - Rebound in the right iliac fossa: acute appendicitis; in the left iliac fossa: diverticulitis; generalized: diffuse peritonitis from perforation. - It also occurs in pelvic inflammatory disease, ruptured ectopic pregnancy and complicated cholecystitis. - A negative rebound does not exclude peritonitis in older adults, immunosuppressed patients or after analgesia, nor in retrocecal appendicitis. ## Usefulness and limits - In words: moderate usefulness; its diagnostic value has been debated and it is less reproducible between examiners than rigidity. - Percussion tenderness usually gives the same information with less pain and is preferred by many examiners. - When an acute abdomen is suspected, imaging (ultrasound or CT) and surgical review are not delayed by the result of the sign. ## Test yourself Think of the answer, then tap the question to see it. ## What is Blumberg sign? Pain that appears or increases when the hand is lifted quickly after pressing slowly into the abdomen; it signals parietal peritoneal irritation. ## Why does rebound point to the parietal peritoneum rather than the organ? The parietal peritoneum has somatic nerve supply that localizes pain, while the visceral peritoneum has only autonomic supply. ## Which gentler tests are used instead of rebound? Percussion tenderness, pain on coughing and pain on dropping onto the heels. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/rebound-tenderness/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Peritoneum](https://durgical.com/en/anatomy/peritoneum/) - [Rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/) - [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/) ## Related - [McBurney point](https://durgical.com/en/clinical-exam/mcburney-point/) - [Rovsing, psoas and obturator signs](https://durgical.com/en/clinical-exam/rovsing-psoas-and-obturator-signs/) - [Abdominal palpation: light and deep, guarding and masses](https://durgical.com/en/clinical-exam/abdominal-palpation-light-and-deep-guarding-and-masses/) - [Abdominal percussion: liver span and tympany](https://durgical.com/en/clinical-exam/abdominal-percussion-liver-span-and-tympany/) - [Acute abdomen and peritoneal irritation](https://durgical.com/en/clinical-exam/acute-abdomen-and-peritoneal-irritation/) ## Related conditions - [Acute appendicitis](https://durgical.com/en/conditions/acute-appendicitis/) - [Peritonitis](https://durgical.com/en/conditions/peritonitis/) - [Diverticular disease and diverticulitis](https://durgical.com/en/conditions/diverticular-disease-and-diverticulitis/) - [Acute cholecystitis](https://durgical.com/en/conditions/acute-cholecystitis/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Blumberg's sign](https://en.wikipedia.org/wiki/Blumberg_sign) (Wikipedia, 2026); [Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/gastrointestinal-disorders/approach-to-the-gastrointestinal-patient/evaluation-of-the-gastrointestinal-patient) (Merck & Co., Inc., 2025); [Appendicitis - Gastroenterology - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/appendicitis) (Merck & Co., Inc., 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/rebound-tenderness/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/rebound-tenderness/