Blumberg's sign (also referred to as rebound tenderness or Shchetkin–Blumberg's sign) is a clinical sign in which there is pain upon removal of pressure rather than application of pressure to the abdomen. (The latter is referred to simply as abdominal tenderness.) It is indicative of peritonitis. It was named after German surgeon Jacob Moritz Blumberg.[1][2]
| Rebound tenderness | |
|---|---|
| ICD-10-PCS | R10.4 |
| ICD-9-CM | 789.6 |
Procedure
editThe abdominal wall is compressed slowly and then rapidly released. A positive sign is indicated by presence of pain upon removal of pressure on the abdominal wall.
Clinical significance
editThe sign indicates aggravation of the parietal peritoneum by stretching or moving. Positive Blumberg's sign is indicative of peritonitis,[3] which can occur in diseases like appendicitis, and may occur in ulcerative colitis with rebound tenderness in the right lower quadrant.
However, in recent years[when?] the value of rebound tenderness has been questioned, since it may not add any diagnostic value beyond the observation that the patient has severe tenderness.[4] Use of the sign has been supported by others.[5][6] A study published in 2022 found that a positive Blumberg's sign made the diagnosis of acute appendicitis more likely, but that a negative sign did not rule out the diagnosis. In that sense, a positive Blumberg's sign serves as a tool to supplement clinical diagnosis.[7]
See also
editReferences
edit- ^ synd/2449 at Who Named It?
- ^ J. M. Blumberg. Ein neues diagnostisches Symptom bei Appendicitis. Münchener medizinische Wochenschrift, 1907, 54: 1177-1178.
- ^ Dale Berg (2004). Advanced clinical skills and physical diagnosis. Wiley-Blackwell. p. 119. ISBN 978-1-4051-0433-3.
- ^ Liddington MI, Thomson WHF. Rebound tenderness test. British Journal of Surgery, 1991, 78: 795–796
- ^ Bundy, DG.; Byerley, JS.; Liles, EA.; Perrin, EM.; Katznelson, J.; Rice, HE. (July 2007). "Does this child have appendicitis?". JAMA. 298 (4): 438–51. doi:10.1001/jama.298.4.438. PMC 2703737. PMID 17652298.
- ^ Golledge, J.; Toms, AP.; Franklin, IJ.; Scriven, MW.; Galland, RB. (January 1996). "Assessment of peritonism in appendicitis". Ann R Coll Surg Engl. 78 (1): 11–4. PMC 2502643. PMID 8659965.
- ^ Yale, Steven Howard; Tekiner, Halil; Yale, Eileen Scott (27 July 2022). "Signs and syndromes in acute appendicitis: A pathophysiologic approach". World Journal of Gastrointestinal Surgery. 14 (7): 727–730. doi:10.4240/wjgs.v14.i7.727. ISSN 1948-9366. PMC 9353750. PMID 36158282.