What Is the Obturator Sign?

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  • Written By: Dan Harkins
  • Edited By: Kaci Lane Hindman
  • Last Modified Date: 23 October 2019
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Physicians use a variety of patient manipulations in the examination room to confirm suspected diagnoses so that a treatment plan can be initiated as quickly as possible. An exam called the obturator sign test is often performed when appendicitis is the culprit — the case for about 7 percent of the population in their lifetimes. This involves the doctor manipulating the right leg inward to slightly compress the pelvic region. Pain during this movement will indicate that a patient might have an inflamed appendix, which is a seemingly useless little nub that is attached to the lower small intestine.

Before a doctor will confirm appendicitis through an x-ray and recommend surgical excision, the obturator sign test helps to isolate the damage. With the patient lying supine, the doctor will flex the patient's right leg by bending the knee. Then the doctor will bring the knee in toward the chest and rotate it inward toward the navel. The patient is then asked to indicate whether the pain intensifies during the obturator sign test.


Other common tests are used in concert with the obturator sign to fully confirm a clinical diagnosis of appendicitis. Some also press lightly into the patient's McBurney's point, which is located three-quarters of the way from the patient's navel to the hip. This is the approximate location of the appendix. Another test, called the Psoas sign test, has the supine patient's right leg straight, with pressure applied to the top of the knee. When the patient attempts to lift the knee, shooting pain will be a further indication of appendicitis.

Acute appendicitis most often rears its head in a pain that radiates from the navel down to where the appendix is attached to the small intestine, near the right pelvic joint. Several other symptoms might be present as well, from fever and nausea to vomiting and a loss of appetite. The major sign, however, is abdominal pain that cannot be ignored, particularly when coughing or moving the right pelvic joint, which is the basic purpose of an obturator sign exam. If left untreated, the appendix could painfully rupture, causing an immediate risk of developing peritonitis, which is an immediately life-threatening internal infection.

The appendix is still a mysterious phenomenon as of 2011. Medical experts still do not quite know why it exists, since removing it does not seem to have any marked effect on the patient. According to the American Academy of Family Physicians, the condition is the most common reason why a person must have surgical intervention in the abdomen, most often happening to those between the ages of 10 and 30. Appendicitis is typically caused by various bacterial infections.


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