Physical Exam

Rovsing Sign

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Video coming September 2026

How to Perform

Place a flat hand in the left lower quadrant over the descending colon and, pressing firmly, slide the hand upward toward the splenic flexure. A positive test is pain referred to the right lower quadrant.

How to Interpret

Appendicitis

Rovsing sign positive

Rule in

Somewhat helpful

Rule out

—

Evidence:Limited

References

Kinesya E, Cintya EP, Dorothy MJ, et al. 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. (PRISMA/QUADAS-2 systematic review with meta-analysis, 32 studies; pooled the Rovsing sign among Alvarado-score components; Rovsing-specific pooled value in the full-text forest plot.) Range context: Yale SH, Tekiner H, Yale ES. Signs and syndromes in acute appendicitis: A pathophysiologic approach. World J Gastrointest Surg. 2022;14(7):727-730. doi:10.4240/wjgs.v14.i7.727. PMID 36158282 (open-access letter; reports sensitivity 0.16-0.27 / specificity 0.86-0.89 / LR+ 1.49-2.06 / LR- 0.83-0.94 for psoas/obturator/Rovsing collectively, citing Izbicki 1992 [n=686], Jahn 1997, Berry & Malt 1984, Santillanes 2012, Huckins 2013). Per-study tabulation also in Yale SH, Tekiner H, Yale ES. Physical Examination and Appendiceal Signs During Pregnancy. Cureus. 2022;14(2):e22164. doi:10.7759/cureus.22164. PMID 35308656. NOTE: a prior database citation ('Brown SS, Mertz NB, Eom JS, et al.') was fabricated and has been removed; and the prior claim that the 0.16-0.27/0.86-0.89 ranges were confabulated was itself an error (they are in the Yale 2022 WJGS letter, PMID 36158282). Wagner 1996 JAMA Rational Clinical Examination (PMID 8918857), the former anchor, does not provide an adult Rovsing estimate (its adult rule-in findings are right-lower-quadrant pain, rigidity, and periumbilical radiation).
Rovsing NT. Indirektes Hervorrufen des typischen Schmerzes an McBurney's Punkt: Ein Beitrag zur Diagnostik der Appendicitis und Typhlitis. Zentralbl Chir. 1907;34:1257-1259.