Which sign indicates appendicitis when internal rotation of the right leg at the hip and knee causes abdominal discomfort?

• A. Rovsing's sign
• B. Obturator sign
• C. Psoas sign
• D. Rebound tenderness

Answer: (B)

The sign being tested is tenderness triggered by rotating the thigh inward when the hip and knee are flexed, which points to irritation of the obturator nerve/muscle (the obturator sign). When the appendix is inflamed and lies near the pelvis, it can irritate the obturator nerve as the obturator internus muscle is stretched during internal rotation of the thigh. If this maneuver reproduces abdominal (often RLQ) discomfort, it suggests pelvic involvement of the appendix and supports appendicitis.

This differs from a psoas sign, which appears with extension of the hip or resisted knee flexion due to irritation of the psoas muscle, and from rebound tenderness, which indicates generalized peritoneal irritation rather than a localized sign. Rovsing’s sign involves pain in the RLQ with palpation of the LLQ rather than a maneuver focused on hip rotation.