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The psoas sign, also known as Cope's sign (or Cope's psoas test [1]) or Obraztsova's sign, [2] is a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).
Psoas sign – pain with extension of the hip and tensing of the psoas muscle [18] Obturator sign – pain when tensing the obturator muscle [18] Rovsing's sign – pain in the right lower abdominal quadrant on palpation of the left side of the abdomen [18] McBurney's sign – deep tenderness at McBurney's point [18]
Psoas can be palpated with active flexion of the hip. A positive psoas contracture test and pain with palpation reported by the patient indicate clinical significance. Care should be taken around the abdominal organs, especially the colon when palpating deeply.
The iliopsoas muscle is a composite muscle formed from the psoas major muscle, and the iliacus muscle. The psoas major originates along the outer surfaces of the vertebral bodies of T12 and L1–L3 and their associated intervertebral discs. [1] The iliacus originates in the iliac fossa of the pelvis. [2]
Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. [2] Other signs from the Thomas test: opposite/ contralateral hip flexes without knee extension- tight iliopsoas
The obturator sign, also called Cope's obturator test, is an indicator of irritation to the obturator internus muscle. [1]The technique for detecting the obturator sign, called the obturator test, is carried out on each leg in succession.
Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution of the muscle and/or nerve. Patients can have a trigger point in their upper trapezius and when compressed feel pain in their forearm, hand and fingers (S. Goldfinch)
Anterior to the quadratus lumborum are the colon, the kidney, the psoas major muscle, (if present) the psoas minor muscle, and the diaphragm; between the fascia and the muscle are the twelfth thoracic, ilioinguinal, and iliohypogastric nerves. The quadratus lumborum muscle is a continuation of transverse abdominal muscle.