Heel tap sign

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Heel tap sign
Differential diagnosis appendicitis

Heel tap sign, also called heel-jar or jar tenderness, is a clinical sign to identify appendicitis. It is found in patients with localized peritonitis. With the patient supine the right heel is elevated by 10-20 degrees is hit firmly with palm of the examiner's hand. [1]

The prehospital equivalent of this sign is when pain is elicited as the ambulance hits bumps and potholes during the transport of the patient. Pain may be severe and may radiate to other areas with movement.

It is similar to rebound tenderness, but may be easier to elicit when the patient has firm abdominal wall muscles. Abdominal pain on walking or running is an equivalent sign.

Related Research Articles

Appendicitis Inflammation of the appendix

Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis.

Peritonitis Inflammation of the peritoneum

Peritonitis is inflammation of the peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or the entire abdomen may be tender. Complications may include shock and acute respiratory distress syndrome.

Abdominal pain Stomach aches

Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues.

Courvoisier's law states that in the presence of a palpably enlarged gallbladder and accompanied with mild jaundice, the cause is unlikely to be gallstones. Usually, the term is used to describe the physical examination finding of the right-upper quadrant of the abdomen. This sign implicates possible malignancy of the gallbladder or pancreas and the swelling is unlikely due to gallstones.

Rovsings sign

Rovsing's sign, named after the Danish surgeon Niels Thorkild Rovsing (1862–1927), is a sign of appendicitis. If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis. The phenomenon was first described by Swedish surgeon Emil Samuel Perman (1856-1945) writing in the journal Hygiea in 1904.

Blumberg's sign is a clinical sign in which there is pain upon removal of pressure rather than application of pressure to the abdomen. It is indicative of peritonitis. It was named after German surgeon Jacob Moritz Blumberg.

Toxic megacolon

Toxic megacolon is an acute form of colonic distension. It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.

Abdominal examination Physical examination of abdomen

An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The physical examination typically occurs after a thorough medical history is taken, that is, after the physician asks the patient the course of their symptoms. The abdominal examination is conventionally split into four different stages: first, inspection of the patient and the visible characteristics of their abdomen. Auscultation (listening) of the abdomen with a stethoscope. Palpation of the patient's abdomen. Finally, percussion (tapping) of the patient's abdomen and abdominal organs. Depending on the need to test for specific diseases such as ascites, special tests may be performed as a part of the physical examination. An abdominal examination may be performed because the physician suspects a disease of the organs inside the abdominal cavity, or simply as a part of a complete physical examination for other conditions. In a complete physical examination, the abdominal exam classically follows the respiratory examination and cardiovascular examination.

In medicine, Murphy's sign is a maneuver during a physical examination as part of the abdominal examination. It is useful for differentiating pain in the right upper quadrant. Typically, it is positive in cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.

Severs disease

Sever's Disease, otherwise known as apophysitis of the calcaneus, is an inflammation of the growth plate in the heel of growing children. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves when the bone has completed growth or activity is lessened. The pain can be eased through stretching.

Athletic pubalgia, also called sports hernia, core injury, hockey hernia, hockey groin, Gilmore's groin, or groin disruption is a medical condition of the pubic joint affecting athletes.

Costovertebral angle tenderness

Costovertebral angle (CVA) tenderness is pain that results from touching the region inside of the costovertebral angle. The CVA is formed by the 12th rib and the spine. Assessing for CVA tenderness is part of the abdominal exam, and CVA tenderness indicates kidney pathology. 

In medicine, Valentino's syndrome is pain presenting in the right lower quadrant of the abdomen caused by a duodenal ulcer with perforation through the retroperitoneum.

Boas' or Boas's sign is hyperaesthesia below the right scapula can be a symptom in acute cholecystitis. It is one of many signs a medical provider may look for during an abdominal examination.

In medicine, tenderness is pain or discomfort when an affected area is touched. It should not be confused with the pain that a patient perceives without touching. Pain is patient's perception, while tenderness is a sign that a clinician elicits.

In medicine, Carnett's sign is a finding on clinical examination in which (acute) abdominal pain remains unchanged or increases when the muscles of the abdominal wall are tensed. For this part of the abdominal examination, the patient can be asked to lift the head and shoulders from the examination table to tense the abdominal muscles. An alternative is to ask the patient to raise both legs with straight knees.

The Markle sign or jar tenderness is a clinical sign in which pain in the right lower quadrant of the abdomen is elicited by dropping from standing on the toes to the heels with a jarring landing. It is found in patients with localised peritonitis due to acute appendicitis. It is similar to rebound tenderness, but may be easier to elicit when the patient has firm abdominal wall muscles. Abdominal pain on walking or running is an equivalent sign.

Lépine's sign is one of the medical signs of gallbladder disease. It is positive when effleurage with crooked third finger at the point of the gallbladder projection to anterior abdominal wall elicits pain. It is not to be confused with the following:

Quadrants and regions of abdomen

The human abdomen is divided into quadrants and regions by anatomists and physicians for the purposes of study, diagnosis, and treatment. The division into four quadrants allows the localisation of pain and tenderness, scars, lumps, and other items of interest, narrowing in on which organs and tissues may be involved. The quadrants are referred to as the left lower quadrant, left upper quadrant, right upper quadrant and right lower quadrant. These terms are not used in comparative anatomy, since most other animals do not stand erect.

Spleen pain

Spleen pain is a pain felt from the left upper quadrant of the abdomen or epigastrium where the human spleen is located or neighboring.

References

  1. Lawrence, Peter F.; Bell, Richard M.; Dayton, Merril T. (31 October 2012). Essentials of General Surgery. Lippincott Williams & Wilkins. p. 295. ISBN   978-0-7817-8495-5.