Rovsing, psoas and obturator signs !

Sign

Three maneuvers that look for pain at a distance or on moving the right hip; they raise suspicion of appendicitis and show where the appendix lies.

Updated 2026-11-01

See it in 3D: Appendix · Psoas major · Iliacus · Obturator internus · Cecum · Peritoneum

What it is

These three signs complement McBurney point when appendicitis is suspected. In Rovsing sign, pressure in the left iliac fossa causes pain in the right. In the psoas sign, extending the right hip or flexing it against resistance hurts because the inflamed appendix irritates the iliopsoas (retrocecal appendix). In the obturator sign, internally rotating the flexed right hip hurts because a pelvic appendix irritates the obturator internus.

The anatomy it tests

Rovsing: pressure on the left shifts abdominal contents and colonic gas toward the cecum and moves the inflamed parietal peritoneum on the right.
Psoas: the iliopsoas is retroperitoneal and, with the patient supine, lies behind the cecum; extending the hip stretches it and flexing against resistance contracts it against a retrocecal appendix.
Obturator: the obturator internus lines the side wall of the pelvis; internal rotation of the flexed thigh stretches it against a pelvic appendix.

How to elicit it

Rovsing: patient supine with knees flexed; press deeply and steadily with a flat hand in the left iliac fossa and ask where it hurts.
Rovsing is positive only if the pain is felt in the right iliac fossa; pain only on the left or on both sides points to another cause.
Passive psoas: patient on the left side with knees straight; the examiner steadies the hip and extends the right thigh backward.
Active psoas: patient supine; the examiner rests a hand on the right thigh and asks the patient to raise the leg against it.
Obturator: supine, flex the right hip and knee to 90 degrees, holding the knee and the ankle.
Rotate the hip internally by moving the ankle outward while the knee moves toward the midline; watch for hypogastric pain.
Always compare with the left side and record which maneuver was positive.

What a positive result means

Positive Rovsing: peritoneal irritation in the right iliac fossa, classically appendicitis.
Positive psoas: an inflamed retrocecal appendix on the iliopsoas; also a psoas abscess, retroperitoneal hematoma or pyelonephritis with perinephric inflammation.
Positive obturator: a pelvic appendix on the obturator internus; also a pelvic abscess, pelvic inflammatory disease or ectopic pregnancy.
A negative result does not rule out appendicitis; the position of the appendix decides which sign appears.

Usefulness and limits

In words: low sensitivity and moderate specificity for all three; Rovsing sign's sensitivity and specificity have not been well studied.
Their value is to hint at where the appendix lies and to add to clinical scores; ultrasound or CT confirm.

Test yourself

Think of the answer, then tap the question to see it.

How do you test for Rovsing sign, and when is it positive?

Press deeply in the left iliac fossa; it is positive if the pain is felt in the right iliac fossa.

Which position of the appendix does a positive psoas sign suggest?

Retrocecal, because the inflamed appendix lies on the iliopsoas muscle.

How is the obturator sign performed?

Supine, flex the right hip and knee to 90 degrees and rotate the hip internally; hypogastric pain suggests a pelvic appendix.

What else can give a positive psoas sign?

A psoas abscess, retroperitoneal hematoma or perinephric inflammation, besides retrocecal appendicitis.

Add to my cards (4)

See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the 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: Appendicitis - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025); Rovsing's sign (Wikipedia, 2026); Psoas sign (Wikipedia, 2026); Obturator sign (Wikipedia, 2026).

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.