Sign (Medicine)

In medicine, a “sign” is a physical finding that is observed or measured objectively during a physical examination or diagnostic test, such as fever, abdominal sensitivity/tenderness, or abnormal respiratory sounds. Symptoms often accompany signs. A symptom is a subjective complaint of the patient related to the disease that only the patient can describe and the physician cannot determine, such as pain.

There are certain specific signs that point to certain diseases. Some examples of signs that are commonly used in clinical practice include Murphy’s sign for cholecystitis, McBurney’s sign for appendicitis, and Kehr’s sign for spleen injury. These signs are named after the physicians who first described them and are used to aid in the diagnosis of specific medical conditions.

Specific Signs in General Surgery

Chvostek’s sign

A sign of hypocalcemia. It is named after the Czech-Austrian physician František Chvostek !835-1884), who first described it in 1876.

To test for Chvostek’s sign, a healthcare provider will tap or gently stroke the patient’s facial nerve, which is located just in front of the ear and runs down the side of the face. The facial muscles may twitch or contract involuntarily if the patient has hypocalcemia.

Trousseau’s sign (of latent tetany)

Trousseau’s sign is another medical sign that can indicate hypocalcemia (low levels of calcium in the blood). It is named after the French physician Armand Trousseau (1801-1867), who first described it in 1861.

To test for Trousseau’s sign, a healthcare provider will inflate a blood pressure cuff on the patient’s arm above their systolic blood pressure for several (2-3) minutes. If the patient has hypocalcemia, this may cause their hand and fingers to curl inward, with the fingers and wrist assuming a spastic or claw-like posture (i.e., carpopedal spasm). It can also be seen in 15-25% of healthy individuals.

Cullen’s sign

Cullen’s sign is ecchymosis around the umbilicus, a medical sign that typically indicates retroperitoneal bleeding; however, some sources suggest that Cullen’s sign can also be observed in intra-abdominal bleeding. It is named after American surgeon Thomas Stephen Cullen, who first described it in 1918. Cullen’s sign is commonly seen in hemorrhagic pancreatitis, ruptured abdominal aortic aneurysms, and ruptured ectopic pregnancies.

Grey Turner’s sign

Grey Turner’s sign is ecchymosis in the lumbar region, or flank area (the area between the lower ribs and the top of the hip bone). It is named after the British surgeon George Grey Turner, who first described it in 1919. It is an indicator of retroperitoneal bleeding and takes 24-48 hours to appear. It is usually associated with acute pancreatitis and can also be seen in ruptured ectopic pregnancy and aortic aneurysms.

Hamman’s sign

Hamman’s sign is a medical sign that is characterized by the presence of a crunching or crackling sound that is heard with each heartbeat. It is typically heard during auscultation of the heart and is associated with mediastinal emphysema, which is a rare condition characterized by the presence of air in the mediastinum (the space between the lungs).

Hamman’s sign is named after Louis Hamman, an American physician who first described it in 1939. It is often indicative of a ruptured esophagus or a traumatic injury to the chest.

Homan’s sign

A sign of deep vein thrombosis (DVT). Passive dorsiflexion of the foot in a patient with DVT causes pain in the calf. It is named after John Homans, an American surgeon who first described the sign in 1941.

The sign is elicited by passively dorsiflexing a patient’s foot while lying supine. A positive Homan’s sign is the presence of pain in the calf or popliteal region during this maneuver.

Homan’s sign is not a reliable indicator of DVT, as it can be positive in the absence of DVT (approximately ⅕ of cases) and negative in its presence (approximately ⅓ of cases). Other clinical characteristics, such as swelling, redness, warmth, and tenderness of the affected limb, as well as appropriate imaging studies, are required to confirm or exclude the diagnosis of DVT.

Kehr’s sign

Kehr’s sign is the presence of referred pain in the left shoulder, which is caused by irritation or injury to the diaphragm. It is named after Hermann Kehr, a German surgeon who first described the sign in 1903.

The sign is typically seen in patients who have experienced trauma to the abdomen, such as in cases of splenic rupture, where blood from the ruptured spleen irritates the diaphragm, causing pain to radiate to the left shoulder. Kehr’s sign can also be seen in other conditions that cause irritation or injury to the diaphragm, such as peritonitis or pneumonia.

McBurney’s sign

A sign of acute appendicitis. Tenderness at McBurney’s point. When pressure is applied to McBurney’s point, the patient reacts with tenderness. It is named after Charles McBurney, an American surgeon who first described the sign in 1889.

The sign is elicited by applying pressure to a specific point on the abdomen, known as McBurney’s point, which is located approximately one-third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus on the right side of the abdomen. Tenderness or pain at this point is considered a positive McBurney’s sign, which may indicate inflammation of the appendix.

However, it is important to note that McBurney’s sign is not a definitive diagnostic test for appendicitis, as it can be positive for other conditions that cause tenderness in the right lower quadrant of the abdomen, such as diverticulitis or ovarian cysts.

Murphy’s sign

A sign of acute cholecystitis. The sign is elicited by asking the patient to take a deep breath while the examiner applies pressure to the right subcostal area of the abdomen, just below the ribcage. A positive Murphy’s sign is indicated by the patient’s sudden stop in inspiration due to the sharp pain that is felt when the gallbladder comes into contact with the examiner’s fingers.

It is named after John Benjamin Murphy, an American surgeon who first described the sign in 1901.

Murphy’s sign is a highly specific (%93.6) and sensitive (%87.2) sign for cholecystitis. Other clinical features that may be present in patients with cholecystitis include fever, nausea, vomiting, and right upper quadrant abdominal pain.

Rovsing’s sign

A sign of acute appendicitis. When pressure is applied to the left lower quadrant of the abdomen (palpation), pain occurs in the right lower quadrant. Applying pressure to the left lower quadrant of the abdomen causes compression of the colon and increased pressure in the right lower quadrant, where the appendix is located.

It is named after the Danish surgeon Niels Thorkild Rovsing, who first described the sign in 1907.

Rovsing’s sign is not as specific (19% to 75%) or sensitive (58% to 93%) as other signs used to diagnose appendicitis, such as McBurney’s sign, but it can be useful as an additional diagnostic tool.

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