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Old 06-01-2013
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Hammer and Otoscope rebound tenderness

Shall we do rebound tenderness at the same site of the abdominal pain ( eg if the patient has epigastric or RLQ pain - shall I press there -even though when I palpated it hurt the first time?
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Old 06-01-2013
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You can do the rebound tenderness anywhere on the abdomen. It's a sign of peritonitis, so you should be able to elicit it anywhere.
I'd do it together with deep palpation of the painful area. Tell the patient that you're going to release your hand suddenly and to tell you when the pain is more- when you press in or when you release your hand. This way you do both the deep and rebound tenderness together. Hope it helps!
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Old 06-01-2013
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Quote:
Originally Posted by megz2107 View Post
You can do the rebound tenderness anywhere on the abdomen. It's a sign of peritonitis, so you should be able to elicit it anywhere.
I'd do it together with deep palpation of the painful area. Tell the patient that you're going to release your hand suddenly and to tell you when the pain is more- when you press in or when you release your hand. This way you do both the deep and rebound tenderness together. Hope it helps!
Yup...do exactly as Megz said...but make sure you tell the patient, "Im very sorry to cause you this pain but i have to press on your abdomen again, b/c it is a very important finding for my diagnosis"....something along those lines!
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Old 06-01-2013
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Quote:
Originally Posted by dralan View Post
Shall we do rebound tenderness at the same site of the abdominal pain ( eg if the patient has epigastric or RLQ pain - shall I press there -even though when I palpated it hurt the first time?
NEVER do it again at the same site.
However, if light palpation revealed tenderness (e.g. RUQ--> Cholecystitis) then you do the Murphy's and THEN say " I understand it caused you pain but it was necessary for me to reach an accurate diagnosis in order to provide you with the best treatment of your condition. I will not do it again.
The point is : Do everything necessary and then say "as above".
However, if Brudzinski's sign is positive don't do Kernig's----that will be taken as causing unnecessary pain.
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Last edited by Novobiocin; 06-01-2013 at 02:33 PM.
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