During an examination of the abdomen in a patient with right lower quadrant pain the advanced practice registered nurse (APRN) checks for a positive psoas sign. How is this test performed?

A. Pressing on the right lower quadrant and asking the patient to describe where the pain is worse is incorrect because this technique evaluates rebound tenderness, which is a sign of peritoneal irritation but does not specifically assess the psoas muscle. Rebound tenderness can indicate appendicitis, peritonitis, or other intra-abdominal inflammation, but it is not the psoas sign. B. Pressing on the left lower quadrant and asking about right-sided pain is incorrect because this describes Rovsing’s sign, which tests for appendiceal irritation indirectly by palpating the opposite quadrant. Rovsing’s sign is distinct from the psoas maneuver, which specifically evaluates irritation of the psoas muscle, often due to a retrocecal appendix. C. Asking the patient to raise their thigh against resistance is correct. The psoas sign is performed either by having the patient actively flex the right hip against resistance while lying supine or passively extending the right hip while the patient lies on their left side. A positive psoas sign produces pain in the right lower quadrant, indicating irritation of the psoas muscle, which is most commonly due to retrocecal appendicitis. This test helps localize inflammation along the posterior abdominal wall. D. Flexing the patient’s right thigh with the knee bent and internally rotating the hip is incorrect because this describes the obturator sign, which evaluates pelvic appendicitis by stretching the obturator internus muscle. It produces pain in the right lower quadrant if the appendix is in a pelvic location, but it is a different maneuver than the psoas test.