Abdominal Physical Signs and Medical Eponyms: Movements and Compression

Abstract

Prior to the advent of modern imaging techniques, maneuvers were performed as part of the physical examination to further assess pathological findings or an acute abdomen and to further improve clinicians' diagnostic acumen to identify the site and cause of disease. Maneuvers such as changing the position of the patient, extremity, or displacing through pressure a particular organ or structure from its original position are typically used to exacerbate or elicit pain. Some of these techniques, also referred to as special tests, are ascribed as medical eponym signs. Data sources: PubMed, Medline, online Internet word searches, textbooks and references from other source text. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign. Conclusion: These active and passive maneuvers of the abdomen, reported as medical signs, have variable performance in medical practice. The lack of diagnostic accuracy may be attributed to confounders such as the position of the organ, modification of the original technique, or lack of performance of the maneuver as originally intended.

Psoas Abscess Presented as Right Hip Pain in a Young Adult With Crohn’s Disease

“…The transmural inflammation of Crohn's disease increases the risk for bowel perforation and formation of fistula that can lead to psoas abscess formation. Although psoas abscess is most commonly present in longstanding Crohn's disease, it can also be its first manifestation [ 4 , 5 ].…”

“…The symptomatology of psoas abscess can vary and as a result, the diagnosis might be delayed until signs of sepsis have established. Fever, flank pain, and hip pain often with antalgic gait are the classic symptoms, however, only 30% of the patients with poas abscess initially present with this triad [ 2 , 4 , 6 , 7 ]. As we see in this case, referred hip pain in patients with long-standing Cohn disease should always raise the suspicion for ongoing psoas abscess formation [ 8 - 10 ].…”

“…The underlying pathophysiology of referred pain to the anterior thigh in iliopsoas abscess involves the irritation of the femoral nerve and specifically of an intermediate femoral cutaneous nerve that provides sensory innervation of the anterior aspect of the thigh [ 4 ]. This radiation of the pain to the anterior thigh instead of the lateral or posterior aspect of the leg should increase the suspicion that the underlying pathology is less likely to involve sciatica or joint [ 4 ].…”

“…Physical examination is crucial in cases of suspected intraabdominal pathology [ 11 ]. Psoas extension test is also known as Cope’s psoas test, is a recommended approach to diagnosing ongoing inflammatory pathology of the psoas muscle [ 4 ]. Psoas extension test is performed by having the patient lie supine on the non-affected side, and hyperextending the hip joint [ 4 ].…”

“…Psoas extension test is also known as Cope’s psoas test, is a recommended approach to diagnosing ongoing inflammatory pathology of the psoas muscle [ 4 ]. Psoas extension test is performed by having the patient lie supine on the non-affected side, and hyperextending the hip joint [ 4 ]. The test is considered positive when irritation or pain is induced by stretching and passively extending the iliopsoas muscle [ 4 ].…”