Physical Exam

Rebound Tenderness

also known as Blumberg's sign

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Video coming September 2026

How to Perform

With the patient supine, press your hand slowly and deeply into the abdomen over the area of tenderness (commonly the right lower quadrant), then suddenly release. A positive test (Blumberg sign) is pain that is sharper on release than during the pressure.

How to Interpret

Appendicitis

Rebound tenderness positive in a child

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Strong

Rebound tenderness positive

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Strong

Peritonitis

Rebound tenderness positive

Rule in

Minimally helpful

Rule out

Somewhat helpful

Evidence:Limited

References

Liddington MI, Thomson WHF. Rebound tenderness test. Br J Surg. 1991 Jul;78(7):795-796. doi:10.1002/bjs.1800780710. PMID 1873703.
Kinesya E, Cintya EP, Dorothy MJ, Ennaidi NN, Rusti HF, Mannagalli Y, Pasaribu EA. Diagnostic accuracy of Alvarado score components in patients with appendicitis: Systematic review and meta-analysis approach. Health Sciences Review 2022;2:100018. doi:10.1016/j.hsr.2022.100018.
Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007 Jul 25;298(4):438-451. doi:10.1001/jama.298.4.438. PMID: 17652298. PMC: PMC2703737 (free article). JAMA Rational Clinical Examination series systematic review with random-effects meta-analysis of pediatric appendicitis literature. Search MEDLINE January 1966 - March 2007 + Cochrane Database + textbook bibliographies; 2521 potentially relevant articles screened. Rebound tenderness pooled summary LR+ 3.0 (95% CI 2.3-3.9) and summary LR- 0.28 (95% CI 0.14-0.55) both directly reported with CIs that exclude 1. Inter-examiner kappa 0.54 (best among 7 clinical findings assessed). Conclusion: clinical examination does not establish diagnosis but selects children for immediate surgical assessment, further imaging, or observation.
Blumberg JM. Ueber ein neues diagnostisches Symptom bei Appendicitis. Münchener Medizinische Wochenschrift. 1907;54(1):1177-1178.