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Old 07-05-2012
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Question Re-examining a painful abdominal area!

Hey guys,

In case a patient with abdominal pain, suppose RLQ pain, during the examination, he will be in pain many times, one during superficial palpation, another one in deep palpation, another one during rebound tenderness, another one during Rovsing sign and lastly during performing psoas sign.
So how should we deal with all this. should we do all this maneuvers or not ? I am so confused because we should not repeat a painful maneuver..right ? so What is your advice? please I need your help. and the same thing if we have a RUQ pain !!!!
I really appreciate your input.
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Old 07-05-2012
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If the SP just moaned or just gave a scrambled face then you can go ahead and do all these tests but if he/she shouted and jumped out of bed and said that was very very painful, then you tell them sorry and that you wouldn't examine the area again and the in Patient Note you mention that deep palpation, rebound, Rovsing's, ...etc were not done because of exquisite tenderness.

Pretty much the case in real practice, if the pain and tenderness is so obvious and evident we don't insist on the other maneuvers. These maneuvers were made to confirm a suspicion of appendicitis (which means not too much tenderness in the initial palpation).

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